Provider Demographics
NPI:1144360942
Name:DR. JEROME A. BERGAMINI ORAL & MAXILLO FACIAL SURGERY, LLC
Entity type:Organization
Organization Name:DR. JEROME A. BERGAMINI ORAL & MAXILLO FACIAL SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-357-7273
Mailing Address - Street 1:405 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-357-7273
Mailing Address - Fax:630-357-6599
Practice Address - Street 1:405 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-357-7273
Practice Address - Fax:630-357-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0210014061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty