Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | IL | |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | IL |
NPI | 1013072040 |
---|---|
Provider Name | Dr. Jay Bergamini |
First Address | Naperville, IL 60564-9666 |
Second Address | Naperville, IL 60540-5322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |