Provider Demographics
NPI:1003977927
Name:FLORENTO, BERNARD M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:M
Last Name:FLORENTO
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 1:14560 W MEDLOCK DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-2811
Mailing Address - Country:US
Mailing Address - Phone:602-828-0578
Mailing Address - Fax:
Practice Address - Street 1:2330 N 75TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-1200
Practice Address - Country:US
Practice Address - Phone:623-849-0477
Practice Address - Fax:623-849-6111
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD064321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice