Provider Demographics
NPI:1790869162
Name:BERGH, SCOTT GERALD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:GERALD
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 1:19416 UPPER SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7922
Mailing Address - Country:US
Mailing Address - Phone:907-726-1974
Mailing Address - Fax:
Practice Address - Street 1:2925 DEBARR RD
Practice Address - Street 2:ALASKA VA HEALTHCARE SYSTEM AND REGIONAL OFFICE
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2983
Practice Address - Country:US
Practice Address - Phone:907-257-3703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice