Provider Demographics
NPI:1013053297
Name:BERGER, MAIA NGUYEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAIA
Middle Name:NGUYEN
Last Name:BERGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 W 58TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1108
Mailing Address - Country:US
Mailing Address - Phone:212-757-3183
Mailing Address - Fax:212-757-9134
Practice Address - Street 1:343 W 58TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1108
Practice Address - Country:US
Practice Address - Phone:212-757-3183
Practice Address - Fax:212-757-9134
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist