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Individual
DR. MALCOLM R. BERG
Active
Individual
DR. MALCOLM R. BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17463
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0094708-01
—
TX
05
—
0094708-02
—
TX
01
—
1343876
UNITED CONCORDIA
TX
01
—
806227
UNITED CONCORDIA
TX
Enumeration date
07/29/2005
Last updated
06/09/2008
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