Individual
DUSTIN MICHAEL BERGMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 CHILDRENS PLZ, DAYTON, OH 45404-1815
(937) 641-3477
(937) 641-5410
Mailing address
1430 ABBEY PARK PL, XENIA, OH 45385-7512
(419) 733-6536
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
APRN.CRNA.0020210
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0430074
—
OH
Enumeration date
01/19/2021
Last updated
10/15/2021
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