Provider Demographics
NPI:1871525691
Name:BERGER, RONALD E (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:BERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 RAILROAD AVE
Mailing Address - Street 2:PO BOX 886
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9340
Mailing Address - Country:US
Mailing Address - Phone:315-589-4471
Mailing Address - Fax:
Practice Address - Street 1:3800 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9340
Practice Address - Country:US
Practice Address - Phone:315-589-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00526063Medicaid