Provider Demographics
NPI:1821100595
Name:BERGER, JARED IAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:IAN
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 1:35 BEAVERSON BLVD
Mailing Address - Street 2:STE 3B
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7812
Mailing Address - Country:US
Mailing Address - Phone:732-920-7700
Mailing Address - Fax:732-920-7701
Practice Address - Street 1:35 BEAVERSON BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7856
Practice Address - Country:US
Practice Address - Phone:732-920-7700
Practice Address - Fax:732-920-7701
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI021727001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice