Provider Demographics
NPI:1972730471
Name:JERALD SCHARFENBERG DDS PC
Entity type:Organization
Organization Name:JERALD SCHARFENBERG DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:SCHARFENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-279-3070
Mailing Address - Street 1:135D N ADDISON AVE STE 240
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2809
Mailing Address - Country:US
Mailing Address - Phone:630-279-3070
Mailing Address - Fax:
Practice Address - Street 1:135D N ADDISON AVE STE 240
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2809
Practice Address - Country:US
Practice Address - Phone:630-279-3070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19149761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty