Provider Demographics
NPI:1386680114
Name:SCHARFENBERG, JERALD WALTER (DDS)
Entity Type:Individual
Prefix:
First Name:JERALD
Middle Name:WALTER
Last Name:SCHARFENBERG
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 1:135 N ADDISON AVE
Mailing Address - Street 2:STE. 240
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2819
Mailing Address - Country:US
Mailing Address - Phone:630-279-3070
Mailing Address - Fax:
Practice Address - Street 1:135 N ADDISON AVE
Practice Address - Street 2:STE. 240
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2857
Practice Address - Country:US
Practice Address - Phone:630-279-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A149761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice