Provider Demographics
NPI:1417066085
Name:BERG, ANDREW RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RICHARD
Last Name:BERG
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 1:450 HOME DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275-1204
Mailing Address - Country:US
Mailing Address - Phone:412-788-4545
Mailing Address - Fax:412-788-4922
Practice Address - Street 1:450 HOME DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15275-1204
Practice Address - Country:US
Practice Address - Phone:412-788-4545
Practice Address - Fax:412-788-4922
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031526-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice