MEDICARE: DR. SUZANNE PAULETTE BERGER D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	25670	CA

General Provider Information

NPI Number	:	1598760514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE PAULETTE BERGER D.D.S.

Provider Business Mailing Address
First Line	:	28040 DOROTHY DR
Second Line	:	STE 201
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4916
Country	:	US
Telephone Number	:	818-889-2061
Fax Number	:

Provider Business Practice Location Address
First Line	:	28040 DOROTHY DR
Second Line	:	STE 201
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4916
Country	:	US
Telephone Number	:	818-889-2061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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