Provider Demographics
NPI:1922153790
Name:BERGER, ROBERT FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FREDERICK
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ13548Medicaid
SCSC 1354OtherSTATE ID