Samuel David Berke, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

26255 Issued in CA

Practice address

701 S Raymond Ave
Suite 4B
Fullerton, CA 92831-5201

Phone

(714) 992-2999

Fax

(714) 992-0759

NPI assigned

Nov 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1790859072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 S RAYMOND AVE",
            "address_2": "SUITE 4B",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928315201",
            "telephone_number": "714-992-2999",
            "fax_number": "714-992-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 S RAYMOND AVE",
            "address_2": "SUITE 4B",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928315201",
            "telephone_number": "714-992-2999",
            "fax_number": "714-992-0759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERKE",
        "first_name": "SAMUEL",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "26255",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "B26255-01",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "26255",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leslie Bergado
• Bryan Emmanuel Berges
• David Evan Bergman, DO
• Taylor Bergstedt
• Berke Dental Corporation
• Patricia Berkley, RD
• Mary Louise Bermani, MFT
• Ria Marie Bermudez, RRT
• Vanessa Roxanne Bermudez
• Cristina Bernal

• General Practice Dentistry in Fullerton, CA
• Providers in Fullerton, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.