Provider Demographics
NPI:1073686317
Name:BERVEN, MATTHEW E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:E
Last Name:BERVEN
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 1:5972 CAHILL AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-5500
Mailing Address - Country:US
Mailing Address - Phone:651-455-0068
Mailing Address - Fax:651-455-5133
Practice Address - Street 1:5972 CAHILL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-5500
Practice Address - Country:US
Practice Address - Phone:651-455-0068
Practice Address - Fax:651-455-5133
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice