Active NPI
Diantha Joan Berg, DDS
- General Practice Dentistry
- Tacoma, WA
National Provider Identifier
1598806697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE00006194
- Practice address
- 1202 Martin Luther King Jr Way
Tacoma, WA 98405-3926 - Phone
- (253) 471-4743
- Fax
- (253) 442-8840
- NPI assigned
- Feb 9, 2007
- Last updated
- Nov 12, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE00006194 | WA | Primary |
Addresses
Primary practice location
1202 Martin Luther King Jr Way
Tacoma, WA 98405-3926
Mailing address
1019 Pacific Ave Ste 300
Attn: Credentialing
Tacoma, WA 98402-4488
Phone (253) 597-4550
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6017 | Other | WA | DSHS PROVIDER ID |
| DE00006194 | Other | WA | DENTIST LICENSE |
Other names 1
- Dr. Diantha Joan Bales
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160315000065 | WA | Order and Referring Only - Oral Surgery | 0749586907 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447286400000",
"number": "1598806697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 PACIFIC AVE STE 300",
"address_2": "ATTN: CREDENTIALING",
"city": "TACOMA",
"state": "WA",
"postal_code": "984024488",
"telephone_number": "253-597-4550",
"fax_number": "253-597-4556"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1202 MARTIN LUTHER KING JR WAY",
"city": "TACOMA",
"state": "WA",
"postal_code": "984053926",
"telephone_number": "253-471-4743",
"fax_number": "253-442-8840"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERG",
"first_name": "DIANTHA",
"middle_name": "JOAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-09",
"last_updated": "2015-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE00006194",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DSHS PROVIDER ID",
"identifier": "6017",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTIST LICENSE",
"identifier": "DE00006194",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "DIANTHA",
"last_name": "BALES",
"middle_name": "JOAN",
"prefix": "DR.",
"credential": "DDS",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.