Provider Demographics
NPI:1417033176
Name:BERGARA, STEVEN R
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:R
Last Name:BERGARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S GARFIELD AVE
Mailing Address - Street 2:#216
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801
Mailing Address - Country:US
Mailing Address - Phone:626-289-1148
Mailing Address - Fax:626-289-8327
Practice Address - Street 1:330 S GARFIELD AVE
Practice Address - Street 2:#216
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801
Practice Address - Country:US
Practice Address - Phone:626-289-1148
Practice Address - Fax:626-289-8327
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist