Healthcare Provider Details

I. General information

NPI: 1922051382
Provider Name (Legal Business Name): STEPHEN FRANKLIN BERGEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLONIAL WOODS DR
WEST ORANGE NJ
07052-1614
US

IV. Provider business mailing address

1 COLONIAL WOODS DR
WEST ORANGE NJ
07052-1614
US

V. Phone/Fax

Practice location:
  • Phone: 973-325-2221
  • Fax: 973-325-2391
Mailing address:
  • Phone: 973-325-2271
  • Fax: 973-325-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number028556-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDI 09831
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: