Healthcare Provider Details

I. General information

NPI: 1720081722
Provider Name (Legal Business Name): BRENDA MARIE BERTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 LOVELAND MADEIRA RD
LOVELAND OH
45140-2795
US

IV. Provider business mailing address

3197 LINWOOD AVE
CINCINNATI OH
45208-2962
US

V. Phone/Fax

Practice location:
  • Phone: 513-683-4040
  • Fax:
Mailing address:
  • Phone: 513-871-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-017596
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: