Healthcare Provider Details

I. General information

NPI: 1841020971
Provider Name (Legal Business Name): COURTNEY BERGER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4252 S LINDEN RD
FLINT MI
48507-2953
US

IV. Provider business mailing address

2335 PINEVIEW CT
FLUSHING MI
48433-2500
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-1890
  • Fax:
Mailing address:
  • Phone: 810-875-6426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902018248
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: