Bergeron, Brian Edward
Bergeron, Brian Edward is an individual health care provider with primary practice located at 1430 John Wesley Gilbert Drive , Augusta GA 30912-0001. He recently has only one registered license in Dental Providers / Endodontics, which is considered as his primary health care specialty. Bergeron, Brian Edward can be contacted via phone (706) 721-2151.Contact Information
Primary practice address
1430 John Wesley Gilbert Drive
Augusta GA 30912-0001
Phone: (706) 721-2151
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Endodontics | 1223E0200X | 19662 | Texas |
| Dental Providers / Endodontics | 1223E0200X | DN12265 | Florida |
| Dental Providers / Endodontics | 1223E0200X | DN014614 | Georgia |
Profile Details
| NPI number | 1063403079 |
|---|---|
| LBN Legal business name | Bergeron, Brian Edward |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 31st, 2005 |
| Last updated | Apr 13th, 2023 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1063403079 | NPPES |
| Georgia | MEDICAID | 003137074A | |
| Georgia | MEDICAID | ZX4614 |
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