Individual
MRS. MARIE REBECCA JOANNE BERGEVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
200 MEEHAN ROAD, MALONE, NY 12953
(518) 483-0198
Mailing address
200 MEEHAN RD, MALONE, NY 12953-4728
(518) 483-0198
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
124Q00000X
NY
Other
Enumeration date
02/16/2007
Last updated
07/08/2007
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