Provider Demographics
NPI:1578561130
Name:BERGER, DONALD ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ROY
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 1:140 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3202
Mailing Address - Country:US
Mailing Address - Phone:215-896-7448
Mailing Address - Fax:610-275-4103
Practice Address - Street 1:140 INVERNESS DR
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3202
Practice Address - Country:US
Practice Address - Phone:215-896-7448
Practice Address - Fax:610-275-4103
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI010537001223P0221X
PADS017607L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01766050Medicaid
U13163Medicare UPIN