Berg, Malcolm R.

Berg, Malcolm R. is an individual health care provider with primary practice located at 409 E Crockett St , Luling TX 78648-2601. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Berg, Malcolm R. can be contacted via phone (830) 875-3521.

Contact Information

Primary practice address
409 E Crockett St Luling TX 78648-2601
Phone: (830) 875-3521
Fax: (830) 875-2212
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 17463 Texas

Profile Details

NPI number 1396745493
LBN Legal business name Berg, Malcolm R.
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2005
Last updated Jun 9th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396745493 NPPES
Texas MEDICAID 0094708-01
Texas Other 1343876
Texas MEDICAID 0094708-02
Texas Other 806227

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