Provider Demographics
NPI:1124220827
Name:BERG, ROBERT PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PAUL
Last Name:BERG
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 1:270 NASSAU BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5336
Mailing Address - Country:US
Mailing Address - Phone:516-872-8780
Mailing Address - Fax:516-872-6339
Practice Address - Street 1:270 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5336
Practice Address - Country:US
Practice Address - Phone:516-872-8780
Practice Address - Fax:516-872-6339
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0294771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice