Healthcare Provider Details

I. General information

NPI: 1881782324
Provider Name (Legal Business Name): DENNIS BERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SUFFOLK SQ. STE 200
ISLANDIA NY
11749
US

IV. Provider business mailing address

1601 VETERANS MEMMORIAL HWY STE 200
ISLANDIA NY
11749
US

V. Phone/Fax

Practice location:
  • Phone: 631-348-7777
  • Fax: 631-348-7794
Mailing address:
  • Phone: 631-348-7777
  • Fax: 631-348-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number46370
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number48592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: