| Organization Name: | MATTHEW D. BERG, D.D.S., P.A. |
| NPI Number: | 1063685493 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MATTHEW DOUGLAS BERG (PRESIDENT) |
| Mailing Address: | 2193 Silver Lake Rd Nw New Brighton |
| State: | MN US |
| Postal Code: | 551125331 |
| Phone Number: | 6516333116 |
| Fax Number: | |
| NPI Enumeration Date: | 04/07/2008 |
| NPI Last Update Date: | 05/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | D11937 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |