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General NPI Number Information
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NPI Number | 1386277507
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Entity Type | Individual
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Provider Name | JENNIFER WILLIAMS BERGSTROM DDS, MD
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Gender | Female
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 08/03/2025
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Provider Practice Location Address
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Address Line | 5000 W NATIONAL AVE
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City | MILWAUKEE
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State | WI
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Zip | 53295-3098
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Country | US
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Telephone | 414-384-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 6121 N BAY RIDGE AVE
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City | WHITEFISH BAY
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State | WI
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Zip | 53217-4326
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Country | US
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Telephone | 916-475-4401
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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 | D10925
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 8426620
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 600175115
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License Number State | WI
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