Provider Demographics
NPI:1376708628
Name:BERNARD M. FLORENTO, DDS, PLLC
Entity Type:Organization
Organization Name:BERNARD M. FLORENTO, DDS, PLLC
Other - Org Name:CACTUS DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLORENTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-439-2366
Mailing Address - Street 1:4323 W CACTUS RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2340
Mailing Address - Country:US
Mailing Address - Phone:602-439-2366
Mailing Address - Fax:
Practice Address - Street 1:4323 W CACTUS RD
Practice Address - Street 2:SUITE 17
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2340
Practice Address - Country:US
Practice Address - Phone:602-439-2366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty