Healthcare Provider Details

I. General information

NPI: 1164880779
Provider Name (Legal Business Name): LAUREN BERG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2016
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E BELL RD STE 111
PHOENIX AZ
85022-6639
US

IV. Provider business mailing address

7131 E RANCHO VISTA DR UNIT 3009
SCOTTSDALE AZ
85251-1463
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-7000
  • Fax:
Mailing address:
  • Phone: 318-458-6915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number9586
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: