Healthcare Provider Details

I. General information

NPI: 1841218229
Provider Name (Legal Business Name): JOEL SHELDON BERGER D.D.S.,M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 FROST ST # 311
SAN DIEGO CA
92123-4205
US

IV. Provider business mailing address

8008 FROST ST # 311
SAN DIEGO CA
92123-4205
US

V. Phone/Fax

Practice location:
  • Phone: 858-292-5175
  • Fax: 858-292-9946
Mailing address:
  • Phone: 858-292-5175
  • Fax: 858-292-9946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberG45427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: