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General NPI Number Information
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NPI Number | 1174727648
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Entity Type | Individual
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Provider Name | HARRY ROBERT VAN DEN BERG DDS
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 1501 BOLLINGER CANYON RD STE A
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City | SAN RAMON
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State | CA
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Zip | 94583-1758
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Country | US
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Telephone | 925-838-0665
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Fax | 925-523-6580
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Provider Business Mailing Address
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Address Line | 1501 BOLLINGER CANYON RD SUITE A
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City | SAN RAMON
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State | CA
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Zip | 94583-1758
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Country | US
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Telephone | 925-838-0665
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Fax | 925-838-0668
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 45210
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License Number State | CA
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