Provider Demographics
NPI:1073635926
Name:BERGSRUD, MICHELLE LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LOUISE
Last Name:BERGSRUD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6060 CLEARWATER DR
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55343-9442
Mailing Address - Country:US
Mailing Address - Phone:952-938-8882
Mailing Address - Fax:
Practice Address - Street 1:6060 CLEARWATER DR
Practice Address - Street 2:SUITE 230
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9442
Practice Address - Country:US
Practice Address - Phone:952-938-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN90661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics