Provider Demographics
NPI:1770658775
Name:BERG, KARL G (DDS)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:G
Last Name:BERG
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 1:2765 KELLEY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:MN
Mailing Address - Zip Code:55356-5802
Mailing Address - Country:US
Mailing Address - Phone:952-449-9494
Mailing Address - Fax:
Practice Address - Street 1:2765 KELLEY PKWY STE 140
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:MN
Practice Address - Zip Code:55356-5802
Practice Address - Country:US
Practice Address - Phone:952-449-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN91611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice