Provider Demographics
NPI:1093196651
Name:RAEL BERNSTEIN DDS APC
Entity Type:Organization
Organization Name:RAEL BERNSTEIN DDS APC
Other - Org Name:WOW SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-230-5602
Mailing Address - Street 1:PO BOX 2791
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-0791
Mailing Address - Country:US
Mailing Address - Phone:707-583-8969
Mailing Address - Fax:707-575-5375
Practice Address - Street 1:1252 AIRPORT PARK BLVD
Practice Address - Street 2:SUITE A-1
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482
Practice Address - Country:US
Practice Address - Phone:707-583-8969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty