Individual
DR. LANCE BERGESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
5071 NE 122ND AVE, PORTLAND, OR 97230-1003
(503) 255-5700
Mailing address
5071 NE 122ND AVE, PORTLAND, OR 97230-1003
(503) 255-5700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D10462
OR
1223G0001X
General Practice Dentistry
DE60647187
WA
Other
Enumeration date
07/19/2016
Last updated
07/19/2016
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