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NPI Code Detail

MEDICARE: RHETT ALLEN BERG DDS

MEDICARE: RHETT ALLEN BERG DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program14766CT
21223G0001XGeneral Practice DentistryD14477MN

General Provider Information

NPI Number : 1346703501
Entity Type Code : Individual
Provider Name (Legal Business Name) : RHETT ALLEN BERG DDS
Provider Business Mailing Address
First Line : 1313 PENN AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-3047
Country : US
Telephone Number : 612-543-2500
Fax Number :
Provider Business Practice Location Address
First Line : 1313 PENN AVE N
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55411-3047
Country : US
Telephone Number : 612-543-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2019
Last Update Date : 06/02/2026

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Directions to “ RHETT ALLEN BERG DDS” Practice Location

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