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NPI Code Detail

MEDICARE: DR. SARA S BERGSMA DDS, MS

MEDICARE: DR. SARA S BERGSMA DDS, MS
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
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryL549951MI

General Provider Information

NPI Number : 1699875054
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SARA S BERGSMA DDS, MS
Provider Business Mailing Address
First Line : 545 S GARFIELD AVE
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-3483
Country : US
Telephone Number : 231-935-1440
Fax Number :
Provider Business Practice Location Address
First Line : 545 S GARFIELD AVE
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-3483
Country : US
Telephone Number : 231-935-1440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2006
Last Update Date : 07/08/2007

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