Provider Demographics
NPI:1235345406
Name:BERGMAN, SUZANNE (DDS)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 OFFICERS ROW
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3834
Mailing Address - Country:US
Mailing Address - Phone:360-693-9349
Mailing Address - Fax:360-695-2673
Practice Address - Street 1:701 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3834
Practice Address - Country:US
Practice Address - Phone:360-693-9349
Practice Address - Fax:360-695-2673
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA85501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice