Healthcare Provider Details

I. General information

NPI: 1144360942
Provider Name (Legal Business Name): DR. JEROME A. BERGAMINI ORAL & MAXILLO FACIAL SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 SOUTH MAIN STREET
NAPERVILLE IL
60540
US

IV. Provider business mailing address

405 SOUTH MAIN STREET
NAPERVILLE IL
60540
US

V. Phone/Fax

Practice location:
  • Phone: 630-357-7273
  • Fax: 630-357-6599
Mailing address:
  • Phone: 630-357-7273
  • Fax: 630-357-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number021001406
License Number StateIL

VIII. Authorized Official

Name: MRS. ARLENE LABAS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 630-357-7273