Provider Demographics
NPI:1912194663
Name:BERG, CAROL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:BERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72027 DESERT DR
Mailing Address - Street 2:STE. 100
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4959
Mailing Address - Country:US
Mailing Address - Phone:760-776-5025
Mailing Address - Fax:
Practice Address - Street 1:72027 DESERT DR
Practice Address - Street 2:STE. 100
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4959
Practice Address - Country:US
Practice Address - Phone:760-776-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist