Provider Demographics
NPI:1528103611
Name:JAMES L. BERGE, DDS, PC
Entity type:Organization
Organization Name:JAMES L. BERGE, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:BERGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-363-2810
Mailing Address - Street 1:4444 CONNECTICUT AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2318
Mailing Address - Country:US
Mailing Address - Phone:202-363-2810
Mailing Address - Fax:202-966-3601
Practice Address - Street 1:4444 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2318
Practice Address - Country:US
Practice Address - Phone:202-363-2810
Practice Address - Fax:202-966-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2725261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental