MEDICARE: DR. BERGEN JAMES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	37533	CA

General Provider Information

NPI Number	:	1093062036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERGEN JAMES DDS

Provider Business Mailing Address
First Line	:	1 PARKER AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-2614
Country	:	US
Telephone Number	:	415-668-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PARKER AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-2614
Country	:	US
Telephone Number	:	415-668-3500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2012
Last Update Date	:	08/09/2012

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