Healthcare Provider Details

I. General information

NPI: 1558057562
Provider Name (Legal Business Name): JAMES TYLER BERGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 MISSION RD STE 102
PRAIRIE VILLAGE KS
66208-4216
US

IV. Provider business mailing address

7501 MISSION RD STE 102
PRAIRIE VILLAGE KS
66208-4216
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-4560
  • Fax:
Mailing address:
  • Phone: 913-786-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2026000133
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62466
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7768
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number41405
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: