Provider Demographics
NPI:1588730949
Name:BERGMAN, MAUREEN R (DMD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:R
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 BURNS ROAD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PBG
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-691-1629
Mailing Address - Fax:
Practice Address - Street 1:3375 BURNS ROAD
Practice Address - Street 2:SUITE 209
Practice Address - City:PBG
Practice Address - State:FL
Practice Address - Zip Code:33410
Practice Address - Country:US
Practice Address - Phone:561-691-1629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist