=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255149019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BERGEN GENTLE DENTAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2024
-----------------------------------------------------
Last Update Date | 12/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1033 RIVER RD STE 1
-----------------------------------------------------
City | NEW MILFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07646-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-836-7166
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 HODSKIN PL
-----------------------------------------------------
City | TENAFLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07670-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-587-3685
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER/OWNER
-----------------------------------------------------
Name | SHERWIN CHENG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 551-587-3685
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------