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General NPI Number Information
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NPI Number | 1073605911
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Entity Type | Individual
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Provider Name | BERTRAM HENICK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 04/27/2010
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Provider Practice Location Address
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Address Line | 26560 AGOURA RD SUITE 102
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City | CALABASAS
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State | CA
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Zip | 91302-1926
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Country | US
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Telephone | 818-871-9416
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Fax | 818-865-2079
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Provider Business Mailing Address
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Address Line | 26560 AGOURA RD SUITE 102
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City | CALABASAS
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State | CA
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Zip | 91302-1926
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Country | US
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Telephone | 818-871-9416
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Fax | 818-865-2079
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 16175
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License Number State | CA
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