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General NPI Number Information
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NPI Number | 1417188699
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Entity Type | Organization
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Legal Business Name | BERGER DENTAL, P. A.
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Dates
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Enumeration Date | 08/05/2009
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Last Update Date | 08/05/2009
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Provider Practice Location Address
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Address Line | 1010 N ELM ST SUITE A
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City | DENTON
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State | TX
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Zip | 76201-6905
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Country | US
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Telephone | 940-566-1828
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Fax | 940-566-3915
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Provider Business Mailing Address
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Address Line | 1010 N ELM ST SUITE A
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City | DENTON
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State | TX
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Zip | 76201-6905
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Country | US
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Telephone | 940-566-1828
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Fax | 940-566-3915
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHANE TERRYL BERGER
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Credential | D. D. S.
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Telephone | 940-566-1828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19353
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License Number State | TX
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