Active NPI
Joel Howard Berg, DDS
- Pediatric Dentistry
- Seattle, WA
National Provider Identifier
1063574598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DE00008754
- Practice address
- 1959 NE Pacific St
B242
Seattle, WA 98195-7136 - Phone
- (206) 543-4885
- Fax
- (206) 616-7470
- NPI assigned
- Dec 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DE00008754 | WA | Primary |
| Pediatric Dentistry | 1223P0221X | DS029281R | PA |
Addresses
Primary practice location
1959 NE Pacific St
B242
Seattle, WA 98195-7136
Mailing address
Box 357136
1959 NE Pacific St B242
Seattle, WA 98195-7136
Phone (206) 543-4885
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5041066 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS029281R | PA | MD | Pediatric Dentist |
| DE00008754 | WA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063574598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BOX 357136",
"address_2": "1959 NE PACIFIC ST B242",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981957136",
"telephone_number": "206-543-4885",
"fax_number": "206-616-7470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1959 NE PACIFIC ST",
"address_2": "B242",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981957136",
"telephone_number": "206-543-4885",
"fax_number": "206-616-7470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "JOEL",
"middle_name": "HOWARD",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "WA",
"license": "DE00008754",
"primary": true
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "PA",
"license": "DS029281R",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5041066",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.