Berg, Kenneth Richard
Berg, Kenneth Richard is an sole proprietor health care provider with primary practice located at 3550 Sw Bond Ave , Portland OR 97239-4507. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Berg, Kenneth Richard can be contacted via phone (503) 688-6719.Contact Information
Primary practice address
3550 Sw Bond Ave
Portland OR 97239-4507
Phone: (503) 688-6719
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | D3208 | Oregon |
Profile Details
| NPI number | 1669840518 |
|---|---|
| LBN Legal business name | Berg, Kenneth Richard |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 9th, 2015 |
| Last updated | Sep 9th, 2015 - about 11 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1669840518 | NPPES |
| Oregon | Other | D3208 | DENTAL LICENSE |
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