Provider Demographics
NPI:1013072040
Name:BERGAMINI, JEROME A (DDS)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:A
Last Name:BERGAMINI
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 1:405 S. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5322
Mailing Address - Country:US
Mailing Address - Phone:630-357-7273
Mailing Address - Fax:630-357-6599
Practice Address - Street 1:405 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5322
Practice Address - Country:US
Practice Address - Phone:630-357-7273
Practice Address - Fax:630-357-6599
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190175891223S0112X
IL0210014061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery