Provider Demographics
NPI:1417043605
Name:BERNDT, JEFFREY NOBLE (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:NOBLE
Last Name:BERNDT
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 1:121 S ESTES DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2868
Mailing Address - Country:US
Mailing Address - Phone:919-933-3310
Mailing Address - Fax:
Practice Address - Street 1:121 S ESTES DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2868
Practice Address - Country:US
Practice Address - Phone:919-933-3310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5031380OtherCHPW
WA125277OtherL & I
WA5031380Medicaid
911019392OtherCOMMERCIAL