Individual
MISS BETHANY ANN BERGSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1619 MALLARD RD, BROOK PARK, MN 55007-4712
(218) 464-2962
Mailing address
1619 MALLARD RD, BROOK PARK, MN 55007-4712
(218) 464-2962
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H8918
MN
Other
Enumeration date
09/15/2011
Last updated
09/15/2011
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