Provider Demographics
NPI:1457702987
Name:BERGER, MARTIN THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:THOMAS
Last Name:BERGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT119401223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist