Provider Demographics
NPI:1861564502
Name:FRED C. BERGAMO, DDS, PA
Entity type:Organization
Organization Name:FRED C. BERGAMO, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BERGAMO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-261-0212
Mailing Address - Street 1:500 N FARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4104
Mailing Address - Country:US
Mailing Address - Phone:201-261-0212
Mailing Address - Fax:201-261-6272
Practice Address - Street 1:500 N FARVIEW AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4104
Practice Address - Country:US
Practice Address - Phone:201-261-0212
Practice Address - Fax:201-261-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2201007961001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty