Provider Demographics
NPI:1114111598
Name:BERNARD, ANA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:MARIA
Last Name:BERNARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANA-MARIA
Other - Middle Name:DANIELA
Other - Last Name:CIESIELSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1955 US 1 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3708
Mailing Address - Country:US
Mailing Address - Phone:904-825-5055
Mailing Address - Fax:904-825-6875
Practice Address - Street 1:1955 US 1 S
Practice Address - Street 2:SUITE 100
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3708
Practice Address - Country:US
Practice Address - Phone:904-825-5055
Practice Address - Fax:904-825-6875
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010989A1223G0001X
FLHAD 361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008304900Medicaid
IN200871320Medicaid