Provider Demographics
NPI:1538125026
Name:BERGE, WILLIAM VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:VICTOR
Last Name:BERGE
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 1:17425 23RD AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-2271
Mailing Address - Country:US
Mailing Address - Phone:763-476-7313
Mailing Address - Fax:
Practice Address - Street 1:17425 23RD AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-2271
Practice Address - Country:US
Practice Address - Phone:763-476-7313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8157122300000X
WI5001535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist