Provider Demographics
NPI:1336844083
Name:CITRON, JACOB BERGER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:BERGER
Last Name:CITRON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 W LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4663
Mailing Address - Country:US
Mailing Address - Phone:732-869-5734
Mailing Address - Fax:
Practice Address - Street 1:1828 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-4663
Practice Address - Country:US
Practice Address - Phone:732-869-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program