Provider Demographics
NPI:1114092665
Name:BERGER, RICHARD LEONARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LEONARD
Last Name:BERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11645 BISCAYNE BOULEVARD
Mailing Address - Street 2:SUITE 407
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181
Mailing Address - Country:US
Mailing Address - Phone:305-891-2621
Mailing Address - Fax:305-891-2621
Practice Address - Street 1:11645 BISCAYNE BOULEVARD
Practice Address - Street 2:SUITE 407
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181
Practice Address - Country:US
Practice Address - Phone:305-891-2621
Practice Address - Fax:305-891-7279
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN55231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice