Provider Demographics
NPI:1154721405
Name:BERNAL, MARIA LILIANA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LILIANA
Last Name:BERNAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 TREE TOP DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2146
Mailing Address - Country:US
Mailing Address - Phone:954-558-7995
Mailing Address - Fax:
Practice Address - Street 1:2929 N UNIVERSITY DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5081
Practice Address - Country:US
Practice Address - Phone:954-752-3140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-23
Last Update Date:2014-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20895122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist