Individual
JENNIFER WILLIAMS BERGSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MD
Contact information
Practice address
5000 W NATIONAL AVE, MILWAUKEE, WI 53295-3098
(414) 384-2000
Mailing address
6121 N BAY RIDGE AVE, WHITEFISH BAY, WI 53217-4326
(916) 475-4401
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D10925
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
600175115
WI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
8426620
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386277507
—
OR
Enumeration date
02/17/2020
Last updated
08/03/2025
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