Provider Demographics
NPI:1962403402
Name:BENNARDI, BARBERIO, BENNARDI, PC
Entity type:Organization
Organization Name:BENNARDI, BARBERIO, BENNARDI, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENNARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-546-3419
Mailing Address - Street 1:42 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-1307
Mailing Address - Country:US
Mailing Address - Phone:570-546-3419
Mailing Address - Fax:570-546-7172
Practice Address - Street 1:42 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-1307
Practice Address - Country:US
Practice Address - Phone:570-546-3419
Practice Address - Fax:570-546-7172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027666L1223G0001X
PADS027966L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty