MEDICARE: DR. MATTHEW DOUGLAS 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
1	122300000X	Dentist	D11937	MN

General Provider Information

NPI Number	:	1679592141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DOUGLAS BERG DDS

Provider Business Mailing Address
First Line	:	2193 SILVER LAKE RD NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-5331
Country	:	US
Telephone Number	:	651-235-9227
Fax Number	:

Provider Business Practice Location Address
First Line	:	2193 SILVER LAKE RD NW
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-5331
Country	:	US
Telephone Number	:	651-235-9227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	05/20/2008

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