Healthcare Provider Details

I. General information

NPI: 1629297817
Provider Name (Legal Business Name): DONALD R. BERGER, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 INVERNESS DR
BLUE BELL PA
19422-3202
US

IV. Provider business mailing address

140 INVERNESS DR
BLUE BELL PA
19422-3202
US

V. Phone/Fax

Practice location:
  • Phone: 215-896-7448
  • Fax: 610-275-4103
Mailing address:
  • Phone: 215-896-7448
  • Fax: 610-275-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS017607L
License Number StatePA

VIII. Authorized Official

Name: DR. DONALD ROY BERGER
Title or Position: OWNER
Credential: D.D.S.
Phone: 215-896-7448