Provider Demographics
NPI:1639617590
Name:BERGER, AKIVA REUVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AKIVA
Middle Name:REUVEN
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 1:24300 CHAGRIN BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5629
Mailing Address - Country:US
Mailing Address - Phone:404-513-4789
Mailing Address - Fax:
Practice Address - Street 1:24300 CHAGRIN BLVD STE 111
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5629
Practice Address - Country:US
Practice Address - Phone:216-514-9440
Practice Address - Fax:216-514-9450
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026160122300000X, 122300000X
NY059869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist