Provider Demographics
NPI:1407267123
Name:JESSICA R. BERTOGLIO, DDS, PC
Entity type:Organization
Organization Name:JESSICA R. BERTOGLIO, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERTOGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-893-9099
Mailing Address - Street 1:3049 N BARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60192-2024
Mailing Address - Country:US
Mailing Address - Phone:847-893-9099
Mailing Address - Fax:
Practice Address - Street 1:3049 N BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60192-2024
Practice Address - Country:US
Practice Address - Phone:847-893-9099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty