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General NPI Number Information
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NPI Number | 1427250125
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Entity Type | Organization
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Legal Business Name | ROBERT P BERG, DDS PC
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 10/13/2012
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Provider Practice Location Address
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Address Line | 270 NASSAU BLVD
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City | GARDEN CITY
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State | NY
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Zip | 11530-5336
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Country | US
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Telephone | 516-872-8780
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Fax | 516-872-6339
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Provider Business Mailing Address
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Address Line | 270 NASSAU BLVD
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City | GARDEN CITY
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State | NY
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Zip | 11530-5336
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Country | US
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Telephone | 516-872-8780
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Fax | 516-872-6339
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT P BERG
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Credential | DDS
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Telephone | 516-872-8780
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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 | 029477
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License Number State | NY
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