Healthcare Provider Details

I. General information

NPI: 1598789554
Provider Name (Legal Business Name): DAVID MICHAEL BERTINO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 E MAIN ST
WHITESBORO TX
76273-1709
US

IV. Provider business mailing address

306 E MAIN ST
WHITESBORO TX
76273-1709
US

V. Phone/Fax

Practice location:
  • Phone: 903-564-3451
  • Fax: 903-564-5020
Mailing address:
  • Phone: 903-564-3451
  • Fax: 903-564-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11880
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: