Provider Demographics
NPI:1033298021
Name:JERGER, THOMAS WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:JERGER
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 1:22540 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHRS
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2941
Mailing Address - Country:US
Mailing Address - Phone:586-445-2320
Mailing Address - Fax:586-445-1802
Practice Address - Street 1:22540 HARPER AVE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHRS
Practice Address - State:MI
Practice Address - Zip Code:48080-2941
Practice Address - Country:US
Practice Address - Phone:586-445-2320
Practice Address - Fax:586-445-1802
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010134711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4068883Medicaid
MIU23178Medicare UPIN