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NPI Code Detail

MEDICARE: DR. ROBERT M BERCUTT DDS

MEDICARE:  DR. ROBERT M BERCUTT  DDS
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
1122300000XDentist17433CA

General Provider Information

NPI Number : 1790792455
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT M BERCUTT DDS
Provider Business Mailing Address
First Line : 3756 SANTA ROSALIA DR
Second Line : SUITE #310
City : LOS ANGELES
State : CA
Zip : 90008-3615
Country : US
Telephone Number : 323-292-0369
Fax Number : 323-292-7396
Provider Business Practice Location Address
First Line : 3756 SANTA ROSALIA DR
Second Line : SUITE #310
City : LOS ANGELES
State : CA
Zip : 90008-3615
Country : US
Telephone Number : 323-292-0369
Fax Number : 323-292-7396
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2006
Last Update Date : 07/08/2007

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Directions to “ DR. ROBERT M BERCUTT DDS” Practice Location

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