Active NPI
Chad Robert Bergan, D.D.S.
- General Practice Dentistry
- Fargo, ND
National Provider Identifier
1760720528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2134
- Practice address
- 3115 S. University Dr.
Fargo, ND 58103 - Phone
- (701) 232-8884
- Fax
- (701) 232-6064
- NPI assigned
- Jan 29, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2134 | ND | Primary |
Addresses
Primary practice location
3115 S. University Dr.
Fargo, ND 58103
Mailing address
3115 S. University Dr.
Fargo, ND 58103
Phone (701) 232-8884
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2134 | ND | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1359417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1359417600000",
"number": "1760720528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3115 S. UNIVERSITY DR.",
"city": "FARGO",
"state": "ND",
"postal_code": "58103",
"telephone_number": "701-232-8884",
"fax_number": "701-232-6064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3115 S. UNIVERSITY DR.",
"city": "FARGO",
"state": "ND",
"postal_code": "58103",
"telephone_number": "701-232-8884",
"fax_number": "701-232-6064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGAN",
"first_name": "CHAD",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-01-29",
"last_updated": "2013-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "ND",
"license": "2134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 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.