Provider Demographics
NPI:1053464230
Name:BERENGUER, GASTON (DMD MS)
Entity Type:Individual
Prefix:
First Name:GASTON
Middle Name:
Last Name:BERENGUER
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 S FEDERAL HWY
Mailing Address - Street 2:#201
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994
Mailing Address - Country:US
Mailing Address - Phone:772-288-4444
Mailing Address - Fax:772-288-4446
Practice Address - Street 1:969 S FEDERAL HWY
Practice Address - Street 2:#201
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994
Practice Address - Country:US
Practice Address - Phone:772-288-4444
Practice Address - Fax:772-288-4446
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN159351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics