Provider Demographics
NPI:1417096520
Name:BERNSTEIN, LEONARD S (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:S
Last Name:BERNSTEIN
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 1:4035 MORSAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4871
Mailing Address - Country:US
Mailing Address - Phone:815-398-1376
Mailing Address - Fax:815-398-6399
Practice Address - Street 1:4035 MORSAY DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-4871
Practice Address - Country:US
Practice Address - Phone:815-398-1376
Practice Address - Fax:815-398-6399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19-162311223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics