Provider Demographics
NPI:1518971969
Name:BERGER, CLIFFORD JENS (DDS)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:JENS
Last Name:BERGER
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 1:6 TIDEWATER WAY
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-2128
Mailing Address - Country:US
Mailing Address - Phone:912-352-2324
Mailing Address - Fax:
Practice Address - Street 1:4815 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4418
Practice Address - Country:US
Practice Address - Phone:912-352-2324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0081141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00044459AMedicaid
GAT92030Medicare UPIN