Individual
DR. DIANTHA JOAN BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1202 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-3926
(253) 471-4743
(253) 442-8840
Mailing address
1019 PACIFIC AVE STE 300, ATTN: CREDENTIALING, TACOMA, WA 98402-4488
(253) 597-4550
(253) 597-4556
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00006194
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6017
DSHS PROVIDER ID
WA
01
—
DE00006194
DENTIST LICENSE
WA
Enumeration date
02/09/2007
Last updated
11/12/2015
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