MEDICARE: BERGMAN FAMILY DENTAL

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	122300000X	Dentist	2005018472	MO

General Provider Information

NPI Number	:	1619270337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERGMAN FAMILY DENTAL

Provider Business Mailing Address
First Line	:	15421 CLAYTON RD
Second Line	:	SUITE 302
City	:	BALLWIN
State	:	MO
Zip	:	63011-3161
Country	:	US
Telephone Number	:	636-391-9666
Fax Number	:

Provider Business Practice Location Address
First Line	:	15421 CLAYTON RD
Second Line	:	SUITE 302
City	:	BALLWIN
State	:	MO
Zip	:	63011-3161
Country	:	US
Telephone Number	:	636-391-9666
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. DANIEL E BERGMAN
Credential	:	D.D.S.
Telephone Number	:	636-391-9666

Provider Enumeration Date	:	12/20/2010
Last Update Date	:	12/20/2010

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Directions to “BERGMAN FAMILY DENTAL ” Practice Location

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