Healthcare Provider Details

I. General information

NPI: 1568786671
Provider Name (Legal Business Name): RICHARD M. BERG DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 COPPERFIELD CIR
LITITZ PA
17543-9483
US

IV. Provider business mailing address

54 COPPERFIELD CIR
LITITZ PA
17543-9483
US

V. Phone/Fax

Practice location:
  • Phone: 717-627-3113
  • Fax:
Mailing address:
  • Phone: 717-627-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS025436L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: RICHARD BERG
Title or Position: OWNER
Credential:
Phone: 717-627-3113