Provider Demographics
NPI:1063129955
Name:D. BERGER DENTAL OF ELGIN P.A.
Entity type:Organization
Organization Name:D. BERGER DENTAL OF ELGIN P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEIDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-438-1347
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-1267
Mailing Address - Country:US
Mailing Address - Phone:803-438-1347
Mailing Address - Fax:
Practice Address - Street 1:2521 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045
Practice Address - Country:US
Practice Address - Phone:803-438-1347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty