Provider Demographics
NPI:1427102318
Name:KENNETH W. BERGER, D.D.S., L.L.C.
Entity type:Organization
Organization Name:KENNETH W. BERGER, D.D.S., L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-351-5585
Mailing Address - Street 1:3330 CUMBERLAND BLVD
Mailing Address - Street 2:SUITE T-50
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5995
Mailing Address - Country:US
Mailing Address - Phone:404-351-5585
Mailing Address - Fax:678-241-5585
Practice Address - Street 1:3330 CUMBERLAND BLVD
Practice Address - Street 2:SUITE T-50
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5995
Practice Address - Country:US
Practice Address - Phone:404-351-5585
Practice Address - Fax:678-241-5585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA113881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty