Provider Demographics
NPI:1912048042
Name:BERNARD, DAVID BEN (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BEN
Last Name:BERNARD
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 1:33 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1446
Mailing Address - Country:US
Mailing Address - Phone:860-229-3084
Mailing Address - Fax:860-826-8097
Practice Address - Street 1:33 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1446
Practice Address - Country:US
Practice Address - Phone:860-229-3084
Practice Address - Fax:860-826-8097
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6105122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice