Provider Demographics
NPI:1285832188
Name:BERENSON, GERALD BARRY (DDS)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:BARRY
Last Name:BERENSON
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 1:12 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1739
Mailing Address - Country:US
Mailing Address - Phone:978-443-5247
Mailing Address - Fax:
Practice Address - Street 1:20 JULIO DR
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3056
Practice Address - Country:US
Practice Address - Phone:508-842-6881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist