Provider Demographics
NPI:1992957864
Name:BERNSTEIN, RAEL ILAN (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:RAEL
Middle Name:ILAN
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
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Mailing Address - Street 1:2245 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4900
Mailing Address - Country:US
Mailing Address - Phone:707-575-0600
Mailing Address - Fax:707-230-5620
Practice Address - Street 1:2245 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4900
Practice Address - Country:US
Practice Address - Phone:707-575-0600
Practice Address - Fax:707-230-5620
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics