Provider Demographics
NPI:1639507536
Name:BERG, REBECCA (DDS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:ARUNASALEM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3009 BAYNAM POND DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-5469
Mailing Address - Country:US
Mailing Address - Phone:919-384-6614
Mailing Address - Fax:
Practice Address - Street 1:877 E GANNON AVE STE 401
Practice Address - Street 2:
Practice Address - City:ZEBULON
Practice Address - State:NC
Practice Address - Zip Code:27597-9445
Practice Address - Country:US
Practice Address - Phone:919-269-0103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC116681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice