Healthcare Provider Details

I. General information

NPI: 1083277974
Provider Name (Legal Business Name): ALEXA BERGREN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4175 S ALAMO AVE
DAVIS-MONTHAN AFB AZ
85707
US

IV. Provider business mailing address

4175 S ALAMO AVE
DAVIS-MONTHAN AFB AZ
85707
US

V. Phone/Fax

Practice location:
  • Phone: 520-228-2650
  • Fax:
Mailing address:
  • Phone: 520-228-1506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019034290
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: