Provider Demographics
NPI:1699320796
Name:JOHN B BERG JR DDS PLLC
Entity type:Organization
Organization Name:JOHN B BERG JR DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERICAL
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-624-6241
Mailing Address - Street 1:415 S GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5026
Mailing Address - Country:US
Mailing Address - Phone:423-624-6241
Mailing Address - Fax:
Practice Address - Street 1:415 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5026
Practice Address - Country:US
Practice Address - Phone:423-624-6241
Practice Address - Fax:423-624-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDS4054OtherDENTAL INSURANCE PLANS