Provider Demographics
NPI:1922051382
Name:BERGEN, STEPHEN FRANKLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:FRANKLIN
Last Name:BERGEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1 COLONIAL WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1614
Mailing Address - Country:US
Mailing Address - Phone:973-325-2271
Mailing Address - Fax:973-325-2391
Practice Address - Street 1:1 COLONIAL WOODS DR
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1614
Practice Address - Country:US
Practice Address - Phone:973-325-2221
Practice Address - Fax:973-325-2391
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028556-11223P0700X
NJDI 098311223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics