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General NPI Number Information
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NPI Number | 1366628406
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Entity Type | Individual
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Provider Name | JAMES EDWARD BERG D.D.S. M.S.
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Gender | Male
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Dates
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Enumeration Date | 01/19/2008
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Last Update Date | 02/04/2016
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Provider Practice Location Address
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Address Line | 1820 WASHTENAW RD
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City | YPSILANTI
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State | MI
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Zip | 48197-1703
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Country | US
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Telephone | 734-482-4658
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Fax |
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Provider Business Mailing Address
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Address Line | 1974 N HURON RIVER DR STE 200
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City | YPSILANTI
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State | MI
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Zip | 48197-1654
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Country | US
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Telephone | 734-482-4658
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Fax | 734-482-0233
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11528
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License Number State | MI
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