Provider Demographics
NPI:1093744674
Name:STEVEN BERGMAN, DMD & CLARK INGOLDSBY, DDS, PC
Entity Type:Organization
Organization Name:STEVEN BERGMAN, DMD & CLARK INGOLDSBY, DDS, PC
Other - Org Name:PINNACLE DENTAL AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-843-7905
Mailing Address - Street 1:10 FORBES RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-2605
Mailing Address - Country:US
Mailing Address - Phone:781-843-7905
Mailing Address - Fax:781-356-2388
Practice Address - Street 1:10 FORBES RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-2605
Practice Address - Country:US
Practice Address - Phone:781-843-7905
Practice Address - Fax:781-356-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153491223G0001X
MA183881223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty