Provider Demographics
NPI:1518692540
Name:BERGQUIST-TRACEY, MARGIT ANN
Entity Type:Individual
Prefix:
First Name:MARGIT
Middle Name:ANN
Last Name:BERGQUIST-TRACEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PRIMARY CARE DENTISTRY 8960 BROWN DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5629
Mailing Address - Country:US
Mailing Address - Phone:301-295-2005
Mailing Address - Fax:301-295-3059
Practice Address - Street 1:8960 BROWN DRIVE PRIMARY CARE DENTISTRY
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-2005
Practice Address - Fax:301-295-3059
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56703124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist