Provider Demographics
NPI:1538359112
Name:BRENDAN BERNHART, DDS, PC
Entity type:Organization
Organization Name:BRENDAN BERNHART, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BERNHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-645-8001
Mailing Address - Street 1:3020 HAMAKER CT.
Mailing Address - Street 2:STE. 510
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2220
Mailing Address - Country:US
Mailing Address - Phone:703-645-8001
Mailing Address - Fax:703-645-8002
Practice Address - Street 1:3020 HAMAKER CT.
Practice Address - Street 2:STE. 510
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2220
Practice Address - Country:US
Practice Address - Phone:703-645-8001
Practice Address - Fax:703-645-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105141223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV04290Medicare UPIN