Provider Demographics
NPI:1851576078
Name:JEFFREY I. BERGER DMD
Entity Type:Organization
Organization Name:JEFFREY I. BERGER DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREATMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-542-7331
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEFFREY I. BERGER DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty