Individual
GAIL THERESA BERGEN X
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DA
Contact information
Practice address
427 9TH ST, SAN ANTONIO, TX 78215-1528
(508) 968-6582
Mailing address
427 9TH ST, SAN ANTONIO, TX 78215-1528
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
DA10457
MA
Other
Enumeration date
06/07/2019
Last updated
06/07/2019
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