Neil E Bergstrom, D.D.S.
Individual provider Active NPI General Practice Dentistry · Enumclaw, WA
NPI 1902993363 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1902993363
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 4318 (WA)
- Practice address
- 2660 Griffin Ave
Enumclaw, WA 98022-2325 - Phone
- (360) 825-6596
- Fax
- (360) 802-0797
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 4318 | WA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4318 | WA | Yes |
Addresses
Primary practice location
2660 Griffin Ave
Enumclaw, WA 98022-2325
Mailing address
2660 Griffin Ave
Enumclaw, WA 98022-2325
Phone (360) 825-6596
Other providers in Enumclaw, WA
- Dane Bay
- Nancy Ann Becker
- Vanessa Begazo-Aravena
- K'la Jade Benson
- Justin Andrew Bergstrom
- Todd Alan Bergstrom
- Bethel House Afh LLC
- David R Bhaskar
- Nataliya Bilan
- David H Bishop
All providers in Enumclaw, WA · General Practice Dentistry in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. 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.