Provider Demographics
NPI:1134403801
Name:BERG, STEPHANIE ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANNE
Last Name:BERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LOS GATOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6120
Mailing Address - Country:US
Mailing Address - Phone:408-354-2193
Mailing Address - Fax:408-354-1014
Practice Address - Street 1:8 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6120
Practice Address - Country:US
Practice Address - Phone:408-354-2193
Practice Address - Fax:408-354-1014
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist