Healthcare Provider Details

I. General information

NPI: 1801064043
Provider Name (Legal Business Name): SHERMAN BURTON BERGER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E RAVINE BAYE RD
BAYSIDE WI
53217-1326
US

IV. Provider business mailing address

230 E RAVINE BAYE RD
BAYSIDE WI
53217-1326
US

V. Phone/Fax

Practice location:
  • Phone: 414-352-8122
  • Fax: 414-352-1535
Mailing address:
  • Phone: 414-352-8122
  • Fax: 414-352-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5000750015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: