MEDICARE: DR. LARS BERK D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN14994	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336251487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARS BERK D.M.D.

Provider Business Mailing Address
First Line	:	17040 AYERS RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34604-6806
Country	:	US
Telephone Number	:	352-593-0545
Fax Number	:	844-290-8521

Provider Business Practice Location Address
First Line	:	17040 AYERS RD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34604-6806
Country	:	US
Telephone Number	:	352-593-0545
Fax Number	:	844-290-8521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	11/20/2025

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