Provider Demographics
NPI:1275321192
Name:BERG & LALLY ENDODONTICS LLC
Entity type:Organization
Organization Name:BERG & LALLY ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:LALLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MSD
Authorized Official - Phone:248-866-0760
Mailing Address - Street 1:250 OCHSNER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5257
Mailing Address - Country:US
Mailing Address - Phone:504-391-2324
Mailing Address - Fax:
Practice Address - Street 1:250 OCHSNER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5257
Practice Address - Country:US
Practice Address - Phone:504-391-2324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty