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General NPI Number Information
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NPI Number | 1801062823
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Entity Type | Individual
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Provider Name | PETER A BERGESON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 10/30/2012
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Provider Practice Location Address
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Address Line | 1680 CHAMBERS ST SUITE 204
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City | EUGENE
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State | OR
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Zip | 97402-3655
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Country | US
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Telephone | 541-345-2042
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Fax | 541-345-4012
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Provider Business Mailing Address
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Address Line | 1680 CHAMBERS ST SUITE 204
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City | EUGENE
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State | OR
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Zip | 97402-3655
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Country | US
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Telephone | 541-345-2042
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Fax | 541-345-4012
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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 | 361779-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D9040
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License Number State | OR
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