Provider Demographics
NPI:1053463471
Name:ALLAN K BERNSTEIN D D S P C
Entity Type:Organization
Organization Name:ALLAN K BERNSTEIN D D S P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-820-6800
Mailing Address - Street 1:2034 E SOUTHERN AVE
Mailing Address - Street 2:#H
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7522
Mailing Address - Country:US
Mailing Address - Phone:480-820-6800
Mailing Address - Fax:480-820-6801
Practice Address - Street 1:2034 E SOUTHERN AVE
Practice Address - Street 2:#H
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7522
Practice Address - Country:US
Practice Address - Phone:480-820-6800
Practice Address - Fax:480-820-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT76799Medicare UPIN
AZ6355230001Medicare NSC