Eric P Bergquam, DMD
Individual provider Active NPI General Practice Dentistry · Newberg, OR
NPI 1194035865 · NPPES record last updated Oct 15, 2010
Key facts
- NPI
- 1194035865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D8310 (OR)
- Practice address
- 906 Deborah Rd
Newberg, OR 97132 - Phone
- (503) 538-5476
- Fax
- (503) 538-8293
- NPI assigned
- Oct 15, 2010
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160329001421 | OR | Order and Referring Only - Dentist |
9537466040 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8310 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eric P Bergquam DMD PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D8310 | OR | Yes |
Addresses
Primary practice location
906 Deborah Rd
Newberg, OR 97132
Mailing address
906 Deborah Rd
Newberg, OR 97132
Phone (503) 538-5476
Other providers in Newberg, OR
- Kaitlyn Mae Belanger
- Terri Benner
- Sylvana Elspeth Bennett
- Marcus Bergen
- Ann Marie Berger
- Nina L Bergquam
- Russell Allen Bird
- Marla Bisceglie
- Angela R Bixel
- Bizeau Dental LLC
All providers in Newberg, OR · General Practice Dentistry in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.