Individual
DR. DONALD JAY BERQUIST JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3009 E 92ND ST, CHICAGO, IL 60617-4598
(773) 295-2521
Mailing address
696 LONGFELLOW DR, TROY, MI 48085-4817
(248) 672-8903
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019032682
IL
Other
Enumeration date
10/10/2020
Last updated
10/10/2020
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