Provider Demographics
NPI:1629297817
Name:DONALD R. BERGER, D.D.S., P.C.
Entity Type:Organization
Organization Name:DONALD R. BERGER, D.D.S., P.C.
Other - Org Name:DONALD R. BERGER, D.D.S., P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-896-7448
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017607L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01766050Medicaid
PAU13163Medicare UPIN