Healthcare Provider Details

I. General information

NPI: 1346850690
Provider Name (Legal Business Name): BERLEY DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2020
Last Update Date: 08/02/2020
Certification Date: 08/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 HWY 35
OCEAN NJ
07712-4077
US

IV. Provider business mailing address

1205 HWY 35
OCEAN NJ
07712-4077
US

V. Phone/Fax

Practice location:
  • Phone: 732-531-8020
  • Fax:
Mailing address:
  • Phone: 732-531-8020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: CHAD HENDRICKS
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 612-859-0444