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General NPI Number Information
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NPI Number | 1669937066
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Entity Type | Organization
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Legal Business Name | H ROBERT VAN DEN BERG DDS INC
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Dates
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Enumeration Date | 02/10/2019
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 230 S STERLING DR STE 233
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City | MOUNTAIN HOUSE
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State | CA
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Zip | 95391-3046
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Country | US
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Telephone | 209-650-6560
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Fax | 209-407-3033
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Provider Business Mailing 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 |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARRY ROBERT VAN DEN BERG
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Credential | DDS
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Telephone | 209-650-6560
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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