Provider Demographics
NPI:1356465108
Name:BERNBACH, ALAN LIONEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:LIONEL
Last Name:BERNBACH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:BERNBACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8610 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3404
Mailing Address - Country:US
Mailing Address - Phone:301-589-2714
Mailing Address - Fax:301-589-3828
Practice Address - Street 1:8610 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3404
Practice Address - Country:US
Practice Address - Phone:301-589-2714
Practice Address - Fax:301-589-3828
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics