Provider Demographics
NPI:1821854175
Name:BERGER DENTAL CORPORATION
Entity Type:Organization
Organization Name:BERGER DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VITALIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-955-0669
Mailing Address - Street 1:180 OTAY LAKES RD STE 204
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-2444
Mailing Address - Country:US
Mailing Address - Phone:619-955-0669
Mailing Address - Fax:619-479-9053
Practice Address - Street 1:180 OTAY LAKES RD STE 204
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-2444
Practice Address - Country:US
Practice Address - Phone:619-955-0669
Practice Address - Fax:619-479-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty