Provider Demographics
NPI:1457425787
Name:BERGLASS, MICHAEL ELLIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELLIS
Last Name:BERGLASS
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 1:650 W BOYNTON BEACH BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426
Mailing Address - Country:US
Mailing Address - Phone:561-736-1700
Mailing Address - Fax:561-738-1961
Practice Address - Street 1:650 W BOYNTON BEACH BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426
Practice Address - Country:US
Practice Address - Phone:561-736-1700
Practice Address - Fax:561-738-1961
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81401223G0001X
FLDN17207122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice