Provider Demographics
NPI:1881115194
Name:BERGUIN, WILLIAM JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:BERGUIN
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 1:514 28 RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6555
Mailing Address - Country:US
Mailing Address - Phone:970-241-3483
Mailing Address - Fax:
Practice Address - Street 1:514 28 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6555
Practice Address - Country:US
Practice Address - Phone:970-241-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2032411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO203241OtherCOLORADO DENTAL BOARD