Healthcare Provider Details

I. General information

NPI: 1164343505
Provider Name (Legal Business Name): MADELINE KAY BERST DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 W FOND DU LAC ST
RIPON WI
54971-9289
US

IV. Provider business mailing address

1482 BRIDGEWOOD WAY APT 46
NEENAH WI
54956
US

V. Phone/Fax

Practice location:
  • Phone: 920-299-5549
  • Fax:
Mailing address:
  • Phone: 920-299-5549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number600223315
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: