Provider Demographics
NPI:1699705780
Name:BERG, JOHN F (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:BERG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 SE 4TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3203
Mailing Address - Country:US
Mailing Address - Phone:352-694-6170
Mailing Address - Fax:352-694-6170
Practice Address - Street 1:812 NE 25TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-6379
Practice Address - Country:US
Practice Address - Phone:352-622-3236
Practice Address - Fax:352-622-9422
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL62911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice