Provider Demographics
NPI:1205952066
Name:BERGER, GREGORY ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALAN
Last Name:BERGER
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 1:715 MACARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2621
Mailing Address - Country:US
Mailing Address - Phone:812-482-6610
Mailing Address - Fax:812-634-6610
Practice Address - Street 1:715 MACARTHUR ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2621
Practice Address - Country:US
Practice Address - Phone:812-482-6610
Practice Address - Fax:812-634-6610
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007735A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice