Bruce Alan Vande Berg, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

6408 Issued in NC

Practice address

1010 High House Rd
Suite 100
Cary, NC 27513-3576

Phone

(919) 461-0110

Fax

(919) 461-0114

NPI assigned

Sep 21, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 21, 2016 through Mar 21, 2028

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DRS. Englehardt & Vande Berg, DDS, PA

  • Oral and Maxillofacial Surgery (Dentist)
  • Cary, NC
  • NPI 1891898060
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164521043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 HIGH HOUSE RD",
            "address_2": "SUITE 100",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275133576",
            "telephone_number": "919-461-0110",
            "fax_number": "919-461-0114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 HIGH HOUSE RD",
            "address_2": "SUITE 100",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275133576",
            "telephone_number": "919-461-0110",
            "fax_number": "919-461-0114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDE BERG",
        "first_name": "BRUCE",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "6408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "112637",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "218581",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "98762",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5846074",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Martin Van Cleeff, MD
• Christina Van Donk, PT
• Jacob Van Leeuwen, PHARMD
• Lauren Van Valkenburgh, PT
• Jillian Quinn Van Wagenen, MA, LCMHCA, LCAS
• Jennifer Vande Loo
• Chelsea Vandegrift
• Elizabeth Vandergriff, MD
• Coryn Vanderwall, MS, CF-SLP
• Iris E Vanegas, BEHAVIOR TECHNICIAN

• Dentist in Cary, NC
• Providers in Cary, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.