Provider Demographics
NPI:1013120864
Name:SPLIT ROCK DENTAL ASSOCIATES, P.A.
Entity type:Organization
Organization Name:SPLIT ROCK DENTAL ASSOCIATES, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-287-6611
Mailing Address - Street 1:775 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-4679
Mailing Address - Country:US
Mailing Address - Phone:732-287-6611
Mailing Address - Fax:732-287-6419
Practice Address - Street 1:775 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4679
Practice Address - Country:US
Practice Address - Phone:732-287-6611
Practice Address - Fax:732-287-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI097511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty