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General NPI Number Information
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NPI Number | 1689283509
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Entity Type | Organization
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Legal Business Name | BERKLEY DENTAL PC
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 2645 COOLIDGE HWY
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City | BERKLEY
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State | MI
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Zip | 48072-1554
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Country | US
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Telephone | 248-541-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 13350 SHERWOOD DR
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City | HUNTINGTON WOODS
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State | MI
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Zip | 48070-1433
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Country | US
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Telephone | 248-541-5510
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LAWRENCE WILKOFF
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Credential | DMD
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Telephone | 248-541-5510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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