Individual
DR. SAMUEL D BERTHOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
353 N OLD US HIGHWAY 81, HESSTON, KS 67062-9406
(620) 327-2887
(620) 327-2078
Mailing address
PO BOX 250, HESSTON, KS 67062-0250
(620) 327-2887
(620) 327-2078
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
61875
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15567338
CAQH
KS
Enumeration date
06/02/2022
Last updated
06/02/2022
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