MEDICARE: SUZANNE BERGER, DDS, INC

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	25670	CA

General Provider Information

NPI Number	:	1881807253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUZANNE BERGER, DDS, INC

Provider Business Mailing Address
First Line	:	28040 DOROTHY DR STE 201
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28040 DOROTHY DR STE 201
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4916
Country	:	US
Telephone Number	:	818-889-2061
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUZANNE PAULETTE BERGER
Credential	:	DDS
Telephone Number	:	818-889-2061

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	08/22/2020

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