Provider Demographics
NPI:1417973363
Name:BERGER, HAROLD IRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:IRA
Last Name:BERGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GODWIN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-5200
Mailing Address - Country:US
Mailing Address - Phone:201-891-0008
Mailing Address - Fax:
Practice Address - Street 1:260 GODWIN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-5200
Practice Address - Country:US
Practice Address - Phone:201-891-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ130461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice