Provider Demographics
NPI:1780826735
Name:BERCO, MAURICIO (DDS, DMSC)
Entity Type:Individual
Prefix:DR
First Name:MAURICIO
Middle Name:
Last Name:BERCO
Suffix:
Gender:M
Credentials:DDS, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 STATE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2567
Mailing Address - Country:US
Mailing Address - Phone:978-774-6855
Mailing Address - Fax:978-774-1734
Practice Address - Street 1:6 STATE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2567
Practice Address - Country:US
Practice Address - Phone:978-774-6855
Practice Address - Fax:978-774-1734
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics