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Individual

DR. DANIEL MICHAEL BERGERON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
3112 AIRPORT WAY, SUITE 2, FAIRBANKS, AK 99709-4754
(907) 456-5600
(907) 451-6470
Mailing address
3112 AIRPORT WAY, SUITE 2, FAIRBANKS, AK 99709-4754
(907) 456-5600
(907) 451-6470

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
819
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
822825
TRICARE
AK
05
DD0819
AK
Enumeration date
11/21/2006
Last updated
07/08/2007
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