1962726950 NPI number — IZU & BERGMANN DENTAL ASSOCIATES, INC.

Table of content: (NPI 1962726950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962726950 NPI number — IZU & BERGMANN DENTAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IZU & BERGMANN DENTAL ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962726950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74303 HIGHWAY 111
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
PALM DESERT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92260-4141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-340-0888
Provider Business Mailing Address Fax Number:
760-340-6827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74303 HIGHWAY 111
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92260-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-340-0888
Provider Business Practice Location Address Fax Number:
760-340-6827
Provider Enumeration Date:
03/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAWDEY
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
760-340-0888

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  033244 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223P0300X , with the licence number: 33245 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0700X , with the licence number: 33245 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)