Provider Demographics
NPI:1316113822
Name:BERNELL, BARRY ALAN (DMD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:ALAN
Last Name:BERNELL
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 1:14640 N TATUM BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4824
Mailing Address - Country:US
Mailing Address - Phone:602-971-5570
Mailing Address - Fax:602-787-1639
Practice Address - Street 1:14640 N TATUM BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4824
Practice Address - Country:US
Practice Address - Phone:602-971-5570
Practice Address - Fax:602-787-1639
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21211223P0106X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology