Provider Demographics
NPI:1598983439
Name:BERG, GAIL DEBORAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:DEBORAH
Last Name:BERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HARWOOD CT
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4121
Mailing Address - Country:US
Mailing Address - Phone:914-472-1190
Mailing Address - Fax:
Practice Address - Street 1:14 HARWOOD CT
Practice Address - Street 2:SUITE 312
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4121
Practice Address - Country:US
Practice Address - Phone:914-472-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY388681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics