Provider Demographics
NPI:1275063042
Name:CHIPMAN-BERGSMA, ANNA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:CHIPMAN-BERGSMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:BUUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:260 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MI
Mailing Address - Zip Code:49064
Mailing Address - Country:US
Mailing Address - Phone:269-621-3143
Mailing Address - Fax:269-621-2725
Practice Address - Street 1:260 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MI
Practice Address - Zip Code:49064
Practice Address - Country:US
Practice Address - Phone:269-621-3143
Practice Address - Fax:269-621-2725
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010221981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice