Provider Demographics
NPI:1972344778
Name:BERNARD, VICTORIA GAW (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:GAW
Last Name:BERNARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:PEYTON
Other - Last Name:GAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1359 ISLAND TOWN DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-9027
Mailing Address - Country:US
Mailing Address - Phone:404-775-1326
Mailing Address - Fax:
Practice Address - Street 1:875 UNION AVE STE C211
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3513
Practice Address - Country:US
Practice Address - Phone:901-448-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program