Provider Demographics
NPI:1235269069
Name:BERINGER, FREDERICK PORTER (DDS)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:PORTER
Last Name:BERINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:BERINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:703 S RANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4414
Mailing Address - Country:US
Mailing Address - Phone:225-664-7175
Mailing Address - Fax:
Practice Address - Street 1:703 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4414
Practice Address - Country:US
Practice Address - Phone:225-664-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA26271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1826278Medicaid