Provider Demographics
NPI:1124285143
Name:BERNSTEIN, SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:BERNSTEIN
Suffix:
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 1:15 BOND ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2002
Mailing Address - Country:US
Mailing Address - Phone:516-773-4144
Mailing Address - Fax:
Practice Address - Street 1:15 BOND ST
Practice Address - Street 2:SUITE 203
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2002
Practice Address - Country:US
Practice Address - Phone:516-773-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist