Provider Demographics
NPI:1902078058
Name:BERGER, PETER BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRUCE
Last Name:BERGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 ROCHELLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4110
Mailing Address - Country:US
Mailing Address - Phone:201-556-0037
Mailing Address - Fax:201-556-0116
Practice Address - Street 1:193 ROCHELLE AVE
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4110
Practice Address - Country:US
Practice Address - Phone:201-556-0037
Practice Address - Fax:201-556-0116
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016290001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice