Provider Demographics
NPI:1245323302
Name:JERGER, BRET M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:M
Last Name:JERGER
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 1:2101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4375
Mailing Address - Country:US
Mailing Address - Phone:217-875-3080
Mailing Address - Fax:217-875-3084
Practice Address - Street 1:2101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4375
Practice Address - Country:US
Practice Address - Phone:217-875-3080
Practice Address - Fax:217-875-3084
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0234991223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry