Provider Demographics
NPI:1538454475
Name:BRINGEWALD, BERNHARD HEINRICH (DMD)
Entity type:Individual
Prefix:
First Name:BERNHARD
Middle Name:HEINRICH
Last Name:BRINGEWALD
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:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-0500
Mailing Address - Country:US
Mailing Address - Phone:207-528-8010
Mailing Address - Fax:207-528-2880
Practice Address - Street 1:59 BANGOR ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1740
Practice Address - Country:US
Practice Address - Phone:207-528-8010
Practice Address - Fax:207-528-2880
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN4190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist