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NPI Code Detail

MEDICARE: DR. KENNETH WAYNE BERGER DDS

MEDICARE:  DR. KENNETH WAYNE BERGER  DDS
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
11223G0001XGeneral Practice Dentistry11388GA

General Provider Information

NPI Number : 1629122593
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH WAYNE BERGER DDS
Provider Business Mailing Address
First Line : 3330 CUMBERLAND BLVD
Second Line : SUITE T-50
City : ATLANTA
State : GA
Zip : 30339-5995
Country : US
Telephone Number : 404-351-5585
Fax Number : 678-241-5585
Provider Business Practice Location Address
First Line : 3330 CUMBERLAND BLVD
Second Line : SUITE T-50
City : ATLANTA
State : GA
Zip : 30339-5995
Country : US
Telephone Number : 404-351-5585
Fax Number : 678-241-5585
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 07/08/2007

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Directions to “ DR. KENNETH WAYNE BERGER DDS” Practice Location

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