Provider Demographics
NPI:1295755296
Name:BERGERON, WILLIAM FREDERICK JR (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:BERGERON
Suffix:JR
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 1:111 W 16TH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-6206
Mailing Address - Country:US
Mailing Address - Phone:907-561-1430
Mailing Address - Fax:907-561-2697
Practice Address - Street 1:111 W 16TH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-6206
Practice Address - Country:US
Practice Address - Phone:907-561-1430
Practice Address - Fax:907-561-2697
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1103122300000X
AK1331223S0112X
MD9566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1746707OtherUNITED CONCORDIA
AKDD74733Medicaid
AKDD74731Medicaid