Provider Demographics
NPI:1073704482
Name:BERGER, MARCIE LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:LYNN
Last Name:BERGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 VILLAGE SQUARE CROSSING
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-0122
Mailing Address - Country:US
Mailing Address - Phone:561-626-9887
Mailing Address - Fax:561-627-4451
Practice Address - Street 1:200 VILLAGE SQUARE XING
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3224
Practice Address - Country:US
Practice Address - Phone:561-626-9887
Practice Address - Fax:561-627-4451
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16663122300000X
NY0529641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry