Provider Demographics
NPI:1588762520
Name:BERNARD, JADE T (RDH BS)
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:T
Last Name:BERNARD
Suffix:
Gender:F
Credentials:RDH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18537 BEAR CREEK TER
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-7424
Mailing Address - Country:US
Mailing Address - Phone:571-439-2859
Mailing Address - Fax:703-737-8411
Practice Address - Street 1:163 FORT EVANS RD NE
Practice Address - Street 2:SUITE 160
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4420
Practice Address - Country:US
Practice Address - Phone:703-840-4716
Practice Address - Fax:703-771-1237
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD4592124Q00000X
VA0402004748124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist