MEDICARE: GARY L BERGH DDS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7659	MN

General Provider Information

NPI Number	:	1346320595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY L BERGH DDS, PA

Provider Business Mailing Address
First Line	:	7555 CLOMAN WAY
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-3103
Country	:	US
Telephone Number	:	651-455-2644
Fax Number	:	651-455-2979

Provider Business Practice Location Address
First Line	:	7555 CLOMAN WAY
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-3103
Country	:	US
Telephone Number	:	651-455-2644
Fax Number	:	651-455-2979

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. GARY L. BERGH
Credential	:	DDS
Telephone Number	:	651-455-2644

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/22/2020

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