Bryan Michael Bergens, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DN13806 Issued in FL

Practice address

724 S Beach St
Suite 4
Daytona Beach, FL 32114-5441

Phone

(386) 258-2213

Fax

(386) 253-7943

NPI assigned

May 21, 2013

Last updated

May 21, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bryan M Bergens DDS PA

  • Dentist
  • Daytona Beach, FL
  • NPI 1487760054
  NPD (past)

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

{
    "created_epoch": "1369094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369094400000",
    "number": "1942646617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 S BEACH ST",
            "address_2": "SUITE 4",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321145441",
            "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 S BEACH ST",
            "address_2": "SUITE 4",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321145441",
            "telephone_number": "386-258-2213",
            "fax_number": "386-253-7943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERGENS",
        "first_name": "BRYAN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-21",
        "last_updated": "2013-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "DN13806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1487760054",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allison Marie Berard, M.S., BCBA
• Isabelle Berber
• Jessica Eilene Berent, RN
• Christine Beres
• Toni Ann Bereskie, APRN,BC,MSN,MBA,CS
• Brooke Nicole Bergmann, PHARM.D.
• Jonathan Berlin
• Jacqueline Maher Bernard, M.D.
• Joseph Paul Bernhard Jr., DO
• Bersonn LLC (rastelle manor)

• Periodontics in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Periodontics 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.