# BERGER DENTISTRY SW

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982119871
- **Authorized official:** DR. TIMOTHY BERGER D.M.D. (OWNER)
- **Authorized official phone:** (260) 482-4202

## Contact information

- **Practice address:** 4616 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
- **Practice address phone:** (260) 432-8596
- **Mailing address:** 4616 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
- **Mailing address phone:** (260) 432-8596

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12008676A | IN | Yes |

## Other

- **Enumeration date:** 12/13/2017
- **Last updated:** 12/13/2017