Individual
DR. DEREK ROBERT BERQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
11059 BROADWAY, SUITE B, CROWN POINT, IN 46307-8834
(219) 226-0544
Mailing address
9044 BUNKER HILL DR, MUNSTER, IN 46321-3203
(219) 765-7468
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012546A
IN
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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