Healthcare Provider Details

I. General information

NPI: 1477798205
Provider Name (Legal Business Name): ROY SHELDON BERKON ROY BERKON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 SUMMERLY DR
NASHVILLE TN
37209-4219
US

IV. Provider business mailing address

710 SUMMERLY DR
NASHVILLE TN
37209-4219
US

V. Phone/Fax

Practice location:
  • Phone: 615-356-3799
  • Fax: 615-356-3799
Mailing address:
  • Phone: 615-356-3799
  • Fax: 615-356-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS2385
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: