Provider Demographics
NPI:1447479902
Name:BERGERON, MARIE LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LOUISE
Last Name:BERGERON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1926 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5426
Mailing Address - Country:US
Mailing Address - Phone:559-627-1111
Mailing Address - Fax:556-627-0503
Practice Address - Street 1:1926 S COURT ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-5426
Practice Address - Country:US
Practice Address - Phone:559-627-1111
Practice Address - Fax:556-627-0503
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice