Provider Demographics
NPI:1306804455
Name:BERGSTEIN, MICHAEL EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:BERGSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 HIGHWAY 13 E
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6865
Mailing Address - Country:US
Mailing Address - Phone:952-890-5450
Mailing Address - Fax:952-707-1122
Practice Address - Street 1:1601 HIGHWAY 13 E
Practice Address - Street 2:SUITE 105
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6865
Practice Address - Country:US
Practice Address - Phone:952-890-5450
Practice Address - Fax:952-707-1122
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist