Provider Demographics
NPI:1962726950
Name:IZU & BERGMANN DENTAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:IZU & BERGMANN DENTAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWDEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-340-0888
Mailing Address - Street 1:74303 HIGHWAY 111
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-4141
Mailing Address - Country:US
Mailing Address - Phone:760-340-0888
Mailing Address - Fax:760-340-6827
Practice Address - Street 1:74303 HIGHWAY 111
Practice Address - Street 2:SUITE 2A
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-4141
Practice Address - Country:US
Practice Address - Phone:760-340-0888
Practice Address - Fax:760-340-6827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0332441223G0001X
PA332451223P0300X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty