Provider Demographics
NPI:1477962330
Name:BERGMAN, CHRISTEN (DDS, MS)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:
Last Name:BERGMAN
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 1:607 1/2 JASMINE AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92625-2351
Mailing Address - Country:US
Mailing Address - Phone:509-879-2449
Mailing Address - Fax:
Practice Address - Street 1:27871 MEDICAL CENTER RD STE 260
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-364-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA607258511223P0300X
CA622851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics