Provider Demographics
NPI:1922070051
Name:BERGER DENTAL GROUP, P.A.
Entity Type:Organization
Organization Name:BERGER DENTAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-787-9793
Mailing Address - Street 1:PO BOX 6705
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29260-6705
Mailing Address - Country:US
Mailing Address - Phone:803-787-9793
Mailing Address - Fax:803-738-0300
Practice Address - Street 1:5251 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4920
Practice Address - Country:US
Practice Address - Phone:803-787-9793
Practice Address - Fax:803-738-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ13548Medicaid
SCSC1354OtherDELTA DENTAL INSURANCE ID