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General NPI Number Information
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NPI Number | 1265258867
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Entity Type | Organization
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Legal Business Name | RACHEL E. JACK-BERGLUND DDS INC.
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 4747 N 1ST ST STE 113
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City | FRESNO
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State | CA
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Zip | 93726-0517
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Country | US
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Telephone | 559-225-4540
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Fax |
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Provider Business Mailing Address
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Address Line | 4747 N 1ST ST STE 113
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City | FRESNO
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State | CA
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Zip | 93726-0517
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Country | US
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Telephone | 559-225-4540
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Fax |
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Authorized Official
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Title or Position | OWNER DENTISTS
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Name | RACHEL JACK-BERGLUND
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Credential | DDS
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Telephone | 559-349-6218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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