MEDICARE: BRENDA MARIE BERTSCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	30-017596	OH

General Provider Information

NPI Number	:	1720081722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA MARIE BERTSCH

Provider Business Mailing Address
First Line	:	3197 LINWOOD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-2962
Country	:	US
Telephone Number	:	513-871-2852
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 LOVELAND MADEIRA RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-2795
Country	:	US
Telephone Number	:	513-683-4040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	05/31/2016

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