Provider Demographics
NPI:1952538118
Name:JAEGER, BERNADETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:
Last Name:JAEGER
Suffix:
Gender:F
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:PO BOX 7846
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-7846
Mailing Address - Country:US
Mailing Address - Phone:310-275-9355
Mailing Address - Fax:
Practice Address - Street 1:9615 BRIGHTON WAY
Practice Address - Street 2:SUITE 323
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5131
Practice Address - Country:US
Practice Address - Phone:310-275-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28724122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist