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NPI Code Detail

MEDICARE: PATRICK THOMAS BERG DDS

MEDICARE: PATRICK THOMAS BERG DDS
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
1122300000XDentist1002406-15WI

General Provider Information

NPI Number : 1770195810
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICK THOMAS BERG DDS
Provider Business Mailing Address
First Line : 622 BODART ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-4923
Country : US
Telephone Number : 920-437-7206
Fax Number :
Provider Business Practice Location Address
First Line : 228 S 18TH AVE
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1000
Country : US
Telephone Number : 920-746-3788
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2020
Last Update Date : 10/14/2025

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Directions to “ PATRICK THOMAS BERG DDS” Practice Location

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