Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN16663 | FL |
N | 1223P0221X | Pediatric Dentist | 052964 | NY |
NPI | 1073704482 |
---|---|
Provider Name | Dr. Marcie Lynn Berger |
First Address | Palm Beach Gardens, FL 33410-0122 |
Second Address | Palm Beach Gardens, FL 33410-3224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 18/06/2008 |