William Frederick Bergeron Jr., DDS
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Anchorage, AK
NPI 1295755296 · NPPES record last updated Apr 10, 2008
Key facts
- NPI
- 1295755296
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- License
- 133 (AK)
- Practice address
- 111 W 16TH Ave
Suite 203
Anchorage, AK 99501-6206 - Phone
- (907) 561-1430
- Fax
- (907) 561-2697
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 5, 2018 through Nov 5, 2026
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1103 | AK | MD | Dentist |
| 9566 | MD | MD | Dentist |
| 133 | AK | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alaska Trauma & Acute Care Surgery, LLC | Current | Accepting new patients |
Locations
3220 Providence Dr
Ste E3-080
Anchorage, AK 99508
Phone (907) 375-8785
Interoperability endpoints
- williambergeron@atacs.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1103 | AK | |
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 133 | AK | Yes |
| Dentist | 122300000X | 9566 | MD |
Addresses
Primary practice location
111 W 16TH Ave
Suite 203
Anchorage, AK 99501-6206
Mailing address
111 W 16TH Ave
Suite 203
Anchorage, AK 99501-6206
Phone (907) 561-1430
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1746707 | Other | UNITED CONCORDIA | |
| DD74733 | Medicaid | AK | |
| DD74731 | Medicaid | AK |
Other providers in Anchorage, AK
- David Bergan
- Lisbeth K Berge
- Alanis Berger
- Alexandra Jo Berger
- Doris Cecile Bergeron
- Dustin Bergerson
- Scott Gerald Bergh
- Billie Bergstrom
- Madison Bergstrom
- Steven Bergt
All providers in Anchorage, AK · Oral and Maxillofacial Surgery (Dentist) in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 10, 2008. 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).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.