Provider Demographics
NPI:1992498398
Name:BERG, BETH KAREN (OMT)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:KAREN
Last Name:BERG
Suffix:
Gender:F
Credentials:OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36846 650TH AVE
Mailing Address - Street 2:
Mailing Address - City:WATKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55389-6000
Mailing Address - Country:US
Mailing Address - Phone:320-420-9548
Mailing Address - Fax:
Practice Address - Street 1:36846 650TH AVE
Practice Address - Street 2:
Practice Address - City:WATKINS
Practice Address - State:MN
Practice Address - Zip Code:55389-6000
Practice Address - Country:US
Practice Address - Phone:320-420-9548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH9382124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty