Provider Demographics
NPI:1942372594
Name:BERGAMO, FRED CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:CHARLES
Last Name:BERGAMO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N FARVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4104
Mailing Address - Country:US
Mailing Address - Phone:201-261-0212
Mailing Address - Fax:201-261-6272
Practice Address - Street 1:500 N FARVIEW AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4104
Practice Address - Country:US
Practice Address - Phone:201-261-0212
Practice Address - Fax:201-261-6272
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ220100796100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist