Provider Demographics
NPI:1093895609
Name:BERGH, DUANE LEE (DDS)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:LEE
Last Name:BERGH
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 1:641 ATLANTIC HILLS DR
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MA
Mailing Address - Zip Code:55123
Mailing Address - Country:US
Mailing Address - Phone:651-454-2038
Mailing Address - Fax:651-423-1417
Practice Address - Street 1:14590 SOUTH ROBERT TRAIL
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068
Practice Address - Country:US
Practice Address - Phone:651-423-3993
Practice Address - Fax:651-423-1417
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN87721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice