Provider Demographics
NPI:1427260546
Name:BERGLOFF, JONATHAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:BERGLOFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 E RAY RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-1771
Mailing Address - Country:US
Mailing Address - Phone:480-792-6880
Mailing Address - Fax:480-792-6870
Practice Address - Street 1:1070 E RAY RD
Practice Address - Street 2:SUITE 7
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1771
Practice Address - Country:US
Practice Address - Phone:480-792-6880
Practice Address - Fax:480-792-6870
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD6677122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist