Provider Demographics
NPI:1265258867
Name:RACHEL E. JACK-BERGLUND DDS INC.
Entity type:Organization
Organization Name:RACHEL E. JACK-BERGLUND DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTISTS
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACK-BERGLUND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-349-6218
Mailing Address - Street 1:4747 N 1ST ST STE 113
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-0517
Mailing Address - Country:US
Mailing Address - Phone:559-225-4540
Mailing Address - Fax:
Practice Address - Street 1:4747 N 1ST ST STE 113
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0517
Practice Address - Country:US
Practice Address - Phone:559-225-4540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental