Provider Demographics
NPI:1336864750
Name:WILLOW TREE PEDIATRIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:WILLOW TREE PEDIATRIC DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:202-220-6000
Mailing Address - Street 1:35 CORPORATE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6319
Mailing Address - Country:US
Mailing Address - Phone:203-220-6000
Mailing Address - Fax:203-220-6010
Practice Address - Street 1:35 CORPORATE DR STE 110
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6319
Practice Address - Country:US
Practice Address - Phone:203-220-6000
Practice Address - Fax:203-220-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty