Provider Demographics
NPI:1316081714
Name:BERNARDY, JEFFREY (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:BERNARDY
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 1:1 E LEXINGTON AVE UNIT 901
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2489
Mailing Address - Country:US
Mailing Address - Phone:303-809-2964
Mailing Address - Fax:
Practice Address - Street 1:1130 S COUNTRY CLUB DR UNIT 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-4639
Practice Address - Country:US
Practice Address - Phone:480-833-9866
Practice Address - Fax:480-461-9861
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-18
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0082991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice