Provider Demographics
NPI:1063436574
Name:JACK D BERNS DDS & ANTHONY T DIOGUARDI DMD
Entity type:Organization
Organization Name:JACK D BERNS DDS & ANTHONY T DIOGUARDI DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:T
Authorized Official - Last Name:DIOGUARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-777-2513
Mailing Address - Street 1:123 YORK ST
Mailing Address - Street 2:SUITE 2J
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5614
Mailing Address - Country:US
Mailing Address - Phone:203-777-2513
Mailing Address - Fax:203-776-1714
Practice Address - Street 1:123 YORK ST
Practice Address - Street 2:SUITE 2J
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5614
Practice Address - Country:US
Practice Address - Phone:203-777-2513
Practice Address - Fax:203-776-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6446261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental