Provider Demographics
NPI:1003180142
Name:BERGEN DENTAL AND SPECIALTIES LLC
Entity Type:Organization
Organization Name:BERGEN DENTAL AND SPECIALTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:F
Authorized Official - Last Name:SCHEPIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-343-8888
Mailing Address - Street 1:50 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4341
Mailing Address - Country:US
Mailing Address - Phone:201-343-8888
Mailing Address - Fax:201-845-4341
Practice Address - Street 1:50 ESSEX ST
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4341
Practice Address - Country:US
Practice Address - Phone:201-343-8888
Practice Address - Fax:201-845-4341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO23193001223G0001X
NJ22DIO23185001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty