=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326184474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERGER, MILLER, & MARRON, DDS, DMD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 08/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 NW 70TH AVE SUITE 101
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33317-2385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-791-7530
-----------------------------------------------------
Fax | 954-791-7146
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 NW 70TH AVE SUITE 101
-----------------------------------------------------
City | PLANTATION
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33317-2385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-791-7530
-----------------------------------------------------
Fax | 954-791-7146
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. ROBERT MILLER
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 954-791-7530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 111026
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------