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General NPI Number Information
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NPI Number | 1356359772
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Entity Type | Individual
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Provider Name | DENNIS WILBERT BERGMAN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4041 BARBARA LOOP SE SUITE A
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City | RIO RANCHO
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State | NM
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Zip | 87124-1065
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Country | US
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Telephone | 505-891-1500
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Fax | 505-891-8400
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Provider Business Mailing Address
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Address Line | 13632 CANADA DEL OSO PL NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87111-8030
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Country | US
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Telephone | 505-298-6684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DD-1948
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License Number State | NM
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