DR. BRIAN EDWARD BERGERON DMD NPI 1063403079

NPI Information

  • NPI: 1063403079
  • Provider Name: DR. BRIAN EDWARD BERGERON, DMD
  • Classification: Dentist - 1223E0200X
  • Specialization: Endodontics
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1430 JOHN WESLEY GILBERT DRIVE
    AUGUSTA, GA
    ZIP 30912
  • Phone: (706) 721-2151

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NPI Details

DR. Brian Edward Bergeron, DMD is an endodontics dentist in Augusta, GA. The provider is the branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. DR. Brian Edward Bergeron, DMD NPI is 1063403079. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1430 JOHN WESLEY GILBERT DRIVE
AUGUSTA, GA
ZIP 30912-001
Phone: (706) 721-2151

The NPI 1063403079 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 10/31/2005 and was last updated on 4/13/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223E0200XDentistEndodontics19662TEXASNo
21223E0200XDentistEndodonticsDN12265FLORIDANo
31223E0200XDentistEndodonticsDN014614GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1003137074AMEDICAIDGEORGIA
2ZX4614MEDICAIDSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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