Provider Demographics
NPI:1073732053
Name:BERNDT, SHAWNA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:G
Last Name:BERNDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1819
Mailing Address - Country:US
Mailing Address - Phone:303-857-4377
Mailing Address - Fax:303-857-1533
Practice Address - Street 1:229 DENVER AVE
Practice Address - Street 2:
Practice Address - City:FORT LUPTON
Practice Address - State:CO
Practice Address - Zip Code:80621-1819
Practice Address - Country:US
Practice Address - Phone:303-857-4377
Practice Address - Fax:303-857-1533
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2014-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8634122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist