Healthcare Provider Details

I. General information

NPI: 1770195810
Provider Name (Legal Business Name): PATRICK THOMAS BERG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S 18TH AVE
STURGEON BAY WI
54235-1000
US

IV. Provider business mailing address

622 BODART ST
GREEN BAY WI
54301-4923
US

V. Phone/Fax

Practice location:
  • Phone: 920-746-3788
  • Fax:
Mailing address:
  • Phone: 920-437-7206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1002406-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: