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General NPI Number Information
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NPI Number | 1427077973
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Entity Type | Individual
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Provider Name | KEITH ROBERT CHERTOK DDS
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Gender | Male
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2620 ASHBY AVE STE 101
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City | BERKELEY
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State | CA
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Zip | 94705-2208
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Country | US
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Telephone | 510-548-0150
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Fax | 510-548-0156
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Provider Business Mailing Address
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Address Line | 2620 ASHBY AVE STE 101
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City | BERKELEY
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State | CA
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Zip | 94705-2208
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Country | US
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Telephone | 510-548-0150
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Fax | 510-548-0156
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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 | 38634
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License Number State | CA
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