Provider Demographics
NPI:1306972252
Name:BERNING, DAVID L (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:BERNING
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 1:409 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CARROLL
Mailing Address - State:IA
Mailing Address - Zip Code:51401-2320
Mailing Address - Country:US
Mailing Address - Phone:712-792-4776
Mailing Address - Fax:712-792-1268
Practice Address - Street 1:409 W 7TH ST
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:IA
Practice Address - Zip Code:51401-2320
Practice Address - Country:US
Practice Address - Phone:712-792-4776
Practice Address - Fax:712-792-1268
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA67901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0195925Medicaid