Jennifer E Bergstrom
Dentist - General Practice
413 W Washington Ave
Madison
, Wisconsin 53703-2703
Jennifer E Bergstrom
Dentist - General Practice
413 W Washington Ave
Madison
, Wisconsin 53703-2703
(608) 251-0242
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About
Features
Specialties
- General Practice
Languages spoken
- English
Location
First Address
- Jennifer E Bergstrom
- 413 W Washington Ave
- Madison, WI
- Zip : 53703-2703
- Fax : (608) 251-0242
- Phone : (608) 251-8790
Second Address
- Jennifer E Bergstrom
- 413 W Washington Ave
- Madison, WI
- Zip : 53703-2703
- Fax : (608) 251-0242
- Phone : (608) 251-8790
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223G0001X | General Practice | 5169 | WI |
| Y | 213EG0000X | General Practice | 5169 | WI |
National Provider Identifier
| NPI | 1003915174 |
|---|---|
| Provider Name | Jennifer E Bergstrom |
| First Address | Madison, WI 53703-2703 |
| Second Address | Madison, WI 53703-2703 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/09/2006 |
| Last Update Date | 08/07/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.