Provider Demographics
NPI:1114047537
Name:BERG, WILLIAM GERALD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GERALD
Last Name:BERG
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:GERALD
Other - Last Name:BERG
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:30 NORTH 18TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235
Mailing Address - Country:US
Mailing Address - Phone:920-743-9275
Mailing Address - Fax:920-743-1850
Practice Address - Street 1:30 NORTH 18TH AVENUE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235
Practice Address - Country:US
Practice Address - Phone:920-743-9275
Practice Address - Fax:920-743-1850
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI5000748-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice