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General NPI Number Information
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NPI Number | 1134539216
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Entity Type | Organization
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Legal Business Name | BERKSHIRE ORTHODONTICS
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 04/29/2014
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Provider Practice Location Address
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Address Line | 435 SOUTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-6892
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Country | US
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Telephone | 413-443-0644
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Fax | 413-443-7768
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Provider Business Mailing Address
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Address Line | 435 SOUTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-6892
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JOSEPH CESTONE
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Credential | DMD
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Telephone | 413-443-0644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN1855850
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License Number State | MA
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