Provider Demographics
NPI:1225792906
Name:BERGERON, CLARA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CLARA
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8539 WESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6425
Mailing Address - Country:US
Mailing Address - Phone:703-835-4505
Mailing Address - Fax:
Practice Address - Street 1:6029 BELT LINE RD STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-9196
Practice Address - Country:US
Practice Address - Phone:972-503-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366581223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics