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General NPI Number Information
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NPI Number | 1508911702
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Entity Type | Individual
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Provider Name | NICOLE H BERK DMD
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 04/30/2009
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Provider Practice Location Address
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Address Line | 61 S BLACK HORSE PIKE
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City | BLACKWOOD
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State | NJ
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Zip | 08012-2952
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Country | US
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Telephone | 856-227-2727
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Fax |
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Provider Business Mailing Address
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Address Line | 61 S BLACK HORSE PIKE
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City | BLACKWOOD
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State | NJ
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Zip | 08012-2952
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Country | US
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Telephone | 856-227-2727
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Fax | 856-227-6737
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D021683
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License Number State | NJ
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