Provider Demographics
NPI:1063595569
Name:BERGER, JEFFREY H (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
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 1:6239 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135
Mailing Address - Country:US
Mailing Address - Phone:215-333-8441
Mailing Address - Fax:215-333-8442
Practice Address - Street 1:6239 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3404
Practice Address - Country:US
Practice Address - Phone:215-333-8441
Practice Address - Fax:215-333-8442
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice