Organization
DR. JACKIE BERKOWITZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKIE BERKOWITZ MD (OWNER)
(614) 475-9800
Entity
Organization
Contact information
Practice address
955 N HAMILTON RD, GAHANNA, OH 43230-1758
(614) 475-9800
(614) 475-4222
Mailing address
955 N HAMILTON RD, GAHANNA, OH 43230-1758
(614) 475-9800
(614) 475-4222
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30014268
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122384615051
CARESOURCE
OH
Enumeration date
10/16/2013
Last updated
10/16/2013
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