Healthcare Provider Details

I. General information

NPI: 1518971969
Provider Name (Legal Business Name): CLIFFORD JENS BERGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 PAULSEN ST
SAVANNAH GA
31405-4418
US

IV. Provider business mailing address

6 TIDEWATER WAY
SAVANNAH GA
31411-2128
US

V. Phone/Fax

Practice location:
  • Phone: 912-352-2324
  • Fax:
Mailing address:
  • Phone: 912-352-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number008114
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: