Provider Demographics
NPI:1902920689
Name:BEGLEY, GERARD A (DMD)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:A
Last Name:BEGLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 STATE ROUTE 24
Mailing Address - Street 2:STE 3B
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2918
Mailing Address - Country:US
Mailing Address - Phone:908-879-8339
Mailing Address - Fax:
Practice Address - Street 1:385 STATE RT. 24
Practice Address - Street 2:STE 3B
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930
Practice Address - Country:US
Practice Address - Phone:908-879-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ173661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ029658Medicare ID - Type Unspecified