Provider Demographics
NPI:1770564833
Name:BERETTA, DANTE CARL (MD)
Entity type:Individual
Prefix:
First Name:DANTE
Middle Name:CARL
Last Name:BERETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:525 MAIN ST W
Mailing Address - Street 2:CENTRACARE HEALTH SYSTEM - MELROSE
Mailing Address - City:MELROSE
Mailing Address - State:MN
Mailing Address - Zip Code:56352-1043
Mailing Address - Country:US
Mailing Address - Phone:320-256-4228
Mailing Address - Fax:320-256-7106
Practice Address - Street 1:525 MAIN ST W
Practice Address - Street 2:CENTRACARE HEALTH SYSTEM - MELROSE
Practice Address - City:MELROSE
Practice Address - State:MN
Practice Address - Zip Code:56352-1043
Practice Address - Country:US
Practice Address - Phone:320-256-4228
Practice Address - Fax:320-256-7106
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN37299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1006895OtherPREFERRED ONE
101135OtherMEDICA HEALTH PLANS
47A47BEOtherBLUE CROSS BLUE SHIELD
396023400OtherMEDICAL ASSISTANCE
938027OtherFIRST HEALTH PLAN
HP17770OtherHEALTH PARTNERS
109970OtherU CARE
217795OtherARAZ GROUP AMERICAS PPO
MN37299OtherLICENSE NUMBER
BB4140529OtherDEA
MN37299OtherLICENSE NUMBER
080004235Medicare ID - Type Unspecified
MN080019037Medicare PIN
F90141Medicare UPIN