Provider Demographics
NPI:1639365398
Name:BERGANO, ALLAN LAGASCA
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:LAGASCA
Last Name:BERGANO
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 1:256 N WITCHDUCK RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6544
Mailing Address - Country:US
Mailing Address - Phone:757-497-2988
Mailing Address - Fax:
Practice Address - Street 1:256 N WITCHDUCK RD
Practice Address - Street 2:UNIT D
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6544
Practice Address - Country:US
Practice Address - Phone:757-497-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-0062241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice