Healthcare Provider Details

I. General information

NPI: 1710787213
Provider Name (Legal Business Name): ROBERT JAMES BERGSTROM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. ROBBY BERGSTROM

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 BLANKENSHIP RD STE 230
WEST LINN OR
97068-5100
US

IV. Provider business mailing address

1750 BLANKENSHIP RD STE 230
WEST LINN OR
97068-5100
US

V. Phone/Fax

Practice location:
  • Phone: 503-650-6599
  • Fax:
Mailing address:
  • Phone: 503-650-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12308
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: