Provider Demographics
NPI:1356071245
Name:BERLIN, NICHOLAS SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:BERLIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3172 ROSWELL RD NW APT 1404
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2336
Mailing Address - Country:US
Mailing Address - Phone:404-403-4332
Mailing Address - Fax:
Practice Address - Street 1:11790 NORTHFALL LN STE 401
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-7965
Practice Address - Country:US
Practice Address - Phone:770-777-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1226771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice