Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 12012781A | IN |
N | 1223D0004X | Dentist Anesthesiologist | 12012781A | IN |
NPI | 1144742347 |
---|---|
Provider Name | Dr. Eric John Berger |
First Address | Carmel, IN 46032-1596 |
Second Address | Indianapolis, IN 46202-5187 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2017 |
Last Update Date | 10/07/2017 |