Bethany Ann Bergstad, RDH
Individual provider Active NPI Dental Hygienist · Brook Park, MN
NPI 1487936480 · NPPES record last updated Sep 15, 2011
Key facts
- NPI
- 1487936480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- H8918 (MN)
- Practice address
- 1619 Mallard Rd
Brook Park, MN 55007-4712 - Phone
- (218) 464-2962
- NPI assigned
- Sep 15, 2011
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H8918 | MN | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | H8918 | MN | Yes |
Addresses
Primary practice location
1619 Mallard Rd
Brook Park, MN 55007-4712
Mailing address
1619 Mallard Rd
Brook Park, MN 55007-4712
Phone (218) 464-2962
Other providers in Brook Park, MN
- Brooke Lynn Borst
- Changing Gaits Inc.
- Country Chiropractic Center
- Country Home Comforts LLC
- Christine Hippen
All providers in Brook Park, MN · Dental Hygienist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.