Provider Demographics
NPI:1063968477
Name:RAEL BERNSTEIN DDS A PROF CORP
Entity type:Organization
Organization Name:RAEL BERNSTEIN DDS A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-575-0600
Mailing Address - Street 1:2245 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4900
Mailing Address - Country:US
Mailing Address - Phone:707-575-7545
Mailing Address - Fax:
Practice Address - Street 1:1620 VALLE VISTA AVE
Practice Address - Street 2:STE 200
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2842
Practice Address - Country:US
Practice Address - Phone:707-552-4940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERNSTEIN ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty