Provider Demographics
NPI:1033526645
Name:BERLIN DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:BERLIN DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIEGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-767-7077
Mailing Address - Street 1:7 HARKER AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009-2331
Mailing Address - Country:US
Mailing Address - Phone:856-767-7077
Mailing Address - Fax:856-767-8070
Practice Address - Street 1:7 HARKER AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009-2331
Practice Address - Country:US
Practice Address - Phone:856-767-7077
Practice Address - Fax:856-767-8070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD13308122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty