Provider Demographics
NPI:1811036072
Name:BERGER, JEFFREY IRA (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
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 1:17270 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1032
Mailing Address - Country:US
Mailing Address - Phone:310-542-7331
Mailing Address - Fax:310-542-5154
Practice Address - Street 1:17270 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1032
Practice Address - Country:US
Practice Address - Phone:310-542-7331
Practice Address - Fax:310-542-5154
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics