Provider Demographics
NPI:1245386366
Name:BERNARDINI, ALEX CHRISTOPHER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:CHRISTOPHER
Last Name:BERNARDINI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4227
Mailing Address - Country:US
Mailing Address - Phone:171-898-7404
Mailing Address - Fax:171-866-2141
Practice Address - Street 1:125 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4227
Practice Address - Country:US
Practice Address - Phone:171-898-7404
Practice Address - Fax:171-866-2141
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036731-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice