MEDICARE: SHANNON R BERGERON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1235848375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANNON R BERGERON DDS

Provider Business Mailing Address
First Line	:	8384 JEFFERSON HWY STE 4
Second Line	:
City	:	HARAHAN
State	:	LA
Zip	:	70123-4334
Country	:	US
Telephone Number	:	504-738-9900
Fax Number	:	504-738-9908

Provider Business Practice Location Address
First Line	:	8384 JEFFERSON HWY STE 4
Second Line	:
City	:	HARAHAN
State	:	LA
Zip	:	70123-4334
Country	:	US
Telephone Number	:	504-738-9900
Fax Number	:	504-738-9908

Authorized Official
Title or Position	:	INSURANCE COORDINATOR/FRONT DESK
Name	:	BETH LEGENDRE
Credential	:
Telephone Number	:	504-738-9900

Provider Enumeration Date	:	11/17/2022
Last Update Date	:	11/17/2022

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