Provider Demographics
NPI:1376753681
Name:BARGMANN, CHRISTIAN ANTHONY (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ANTHONY
Last Name:BARGMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27278 E 500 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:IL
Mailing Address - Zip Code:61752-7585
Mailing Address - Country:US
Mailing Address - Phone:309-962-6068
Mailing Address - Fax:
Practice Address - Street 1:102 E CENTER ST
Practice Address - Street 2:SUITE #3
Practice Address - City:LE ROY
Practice Address - State:IL
Practice Address - Zip Code:61752-1900
Practice Address - Country:US
Practice Address - Phone:309-962-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice