Provider Demographics
NPI:1164556668
Name:IGNACIO Z. BERNARDO, JR., D.D.S., INC.
Entity Type:Organization
Organization Name:IGNACIO Z. BERNARDO, JR., D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:ZAPANTA
Authorized Official - Last Name:BERNARDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-442-5136
Mailing Address - Street 1:202 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-2222
Mailing Address - Country:US
Mailing Address - Phone:304-442-5136
Mailing Address - Fax:
Practice Address - Street 1:202 3RD AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2222
Practice Address - Country:US
Practice Address - Phone:304-442-5136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty