Provider Demographics
NPI:1477566263
Name:BERGH, GARY LOY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LOY
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 1:7555 COLMAN WAY E.
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HTS.
Mailing Address - State:MN
Mailing Address - Zip Code:55076-3103
Mailing Address - Country:US
Mailing Address - Phone:651-455-2644
Mailing Address - Fax:651-455-2979
Practice Address - Street 1:7555 COLMAN WAY E.
Practice Address - Street 2:
Practice Address - City:INVER GROVE HTS.
Practice Address - State:MN
Practice Address - Zip Code:55076-3103
Practice Address - Country:US
Practice Address - Phone:651-455-2644
Practice Address - Fax:651-455-2979
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN76591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice