Provider Demographics
NPI:1417268830
Name:BERNS, NICHOLAS JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JEFFREY
Last Name:BERNS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1360
Mailing Address - Country:US
Mailing Address - Phone:219-865-4095
Mailing Address - Fax:219-865-4097
Practice Address - Street 1:1314 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1360
Practice Address - Country:US
Practice Address - Phone:219-865-4095
Practice Address - Fax:219-865-4097
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028355122300000X
IN12012100B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist