Provider Demographics
NPI:1811911969
Name:BERGHOFF, ROBERT H (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:BERGHOFF
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 342
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IN
Mailing Address - Zip Code:46792-0342
Mailing Address - Country:US
Mailing Address - Phone:260-375-2246
Mailing Address - Fax:260-375-2943
Practice Address - Street 1:470 BENNETT DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792
Practice Address - Country:US
Practice Address - Phone:260-375-2246
Practice Address - Fax:260-375-2943
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120078391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice