Provider Demographics
NPI:1033508098
Name:GREGORY A. BERGER DDS
Entity Type:Organization
Organization Name:GREGORY A. BERGER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-482-6610
Mailing Address - Street 1:715 MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2621
Mailing Address - Country:US
Mailing Address - Phone:812-482-6610
Mailing Address - Fax:812-634-6610
Practice Address - Street 1:715 MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2621
Practice Address - Country:US
Practice Address - Phone:812-482-6610
Practice Address - Fax:812-634-6610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty