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General NPI Number Information
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NPI Number | 1073306098
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Entity Type | Organization
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Legal Business Name | SOUTH PENN PLLC
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Dates
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Enumeration Date | 05/22/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 7120 S PENNSYLVANIA AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-3315
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Country | US
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Telephone | 405-681-6601
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Fax |
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Provider Business Mailing Address
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Address Line | 7120 S PENNSYLVANIA AVE
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-3315
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH TREVOR BERG
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Credential | DDS
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Telephone | 208-497-7250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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