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General NPI Number Information
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NPI Number | 1871723395
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Entity Type | Individual
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Provider Name | KENNETH MOSES BERO JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 533 SOUTH MAIN ST. THE GENTLE DENTAL EMPORIUM LLC
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City | WEST BEND
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State | WI
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Zip | 53095
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Country | US
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Telephone | 262-338-8704
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Fax | 262-338-9140
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Provider Business Mailing Address
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Address Line | 533 SOUTH MAIN ST THE GENTLE DENTAL EMPORIUM LLC
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City | WEST BEND
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State | WI
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Zip | 53095
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Country | US
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Telephone | 262-338-8704
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Fax | 262-338-9140
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | WI2517K
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License Number State | WI
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