Bryan M Bergens DDS PA

Primary specialty

DentistTaxonomy code 122300000X

License

DN13806 Issued in FL

Legal business name

BRYAN M BERGENS DDS PA

Practice address

724 South Beach Street
Suite 4
Daytona Beach, FL 32114

Phone

(386) 258-2213

Fax

(386) 253-7943

NPI assigned

Aug 23, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Bridget Rowbatham Bergens

Title

Ceo

Phone

(386) 258-2213

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bryan Michael Bergens, DDS

  • Periodontics
  • Daytona Beach, FL
  • NPI 1942646617
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369094400000",
    "number": "1487760054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 SOUTH BEACH STREET",
            "address_2": "SUITE 4",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-258-2213",
            "fax_number": "386-253-7943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 SOUTH BEACH STREET",
            "address_2": "SUITE 4",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-258-2213",
            "fax_number": "386-253-7943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRYAN M BERGENS DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2013-05-21",
        "status": "A",
        "authorized_official_last_name": "BERGENS",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_middle_name": "ROWBATHAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "386-258-2213",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN13806",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa M Broxton
• Tony L Broxton
• Bruce C. Benedictson, D.D.S. PA
• Sarah Bruce, ARNP
• Shawndolyn Bruten
• Tenisha Bryan Morris
• Lisa Tracy Ann Bryan Ukawuilulu, APRN
• James M Bryan, MD
• Tara Kelly Bryan, CRNA
• Branden Deshawn Bryant

• All providers in Daytona Beach, FL
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.