Bergen, Michele Shoshana

Bergen, Michele Shoshana is an individual health care provider with primary practice located at 49 Lake Ave , Greenwich CT 06830-4501. She recently has 2 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Dental Providers / Oral and Maxillofacial Surgery is her primary health care specialty. Bergen, Michele Shoshana can be contacted via phone (203) 661-4231.

Contact Information

Primary practice address
49 Lake Ave Greenwich CT 06830-4501
Phone: (203) 661-4231
Fax: (203) 661-0155
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 009275 Connecticut
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 042206 Connecticut
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 050181 New York
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X 231685 New York

Profile Details

NPI number 1215929286
LBN Legal business name Bergen, Michele Shoshana
Credentials D.M.D., M.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2005
Last updated Aug 8th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215929286 NPPES
Connecticut MEDICAID 001422063

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