Provider Demographics
NPI:1841588530
Name:BERG, JASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:BERG
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 1:13590 S JOG RD STE 1
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3807
Mailing Address - Country:US
Mailing Address - Phone:561-499-1199
Mailing Address - Fax:561-499-9919
Practice Address - Street 1:13590 S JOG RD STE 1
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-3807
Practice Address - Country:US
Practice Address - Phone:561-499-1199
Practice Address - Fax:561-499-9919
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 196481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice