Provider Demographics
NPI:1679762769
Name:BERGERON, CATHIA (DMD, MS)
Entity Type:Individual
Prefix:
First Name:CATHIA
Middle Name:
Last Name:BERGERON
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE UNIVERSITY OF IOWA COLLEGE OF DENTISTRY
Mailing Address - Street 2:DEPARTEMENT OF OPERATIVE DENTISTRY, DSB S-229
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1010
Mailing Address - Country:US
Mailing Address - Phone:319-335-6990
Mailing Address - Fax:
Practice Address - Street 1:THE UNIVERSITY OF IOWA COLLEGE OF DENTISTRY
Practice Address - Street 2:DEPARTEMENT OF OPERATIVE DENTISTRY, DSB S-229
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1010
Practice Address - Country:US
Practice Address - Phone:319-335-6990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist