Provider Demographics
NPI:1124138177
Name:NATKIN, BERNARD BORIS (DMD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:BORIS
Last Name:NATKIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 WEST LOOP S STE 620
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2420
Mailing Address - Country:US
Mailing Address - Phone:713-981-0000
Mailing Address - Fax:713-665-8885
Practice Address - Street 1:5959 WEST LOOP S STE 620
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2420
Practice Address - Country:US
Practice Address - Phone:713-981-0000
Practice Address - Fax:713-665-8885
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT14992Medicare UPIN
TX00L048Medicare ID - Type UnspecifiedMEDICARE