Provider Demographics
NPI:1417977752
Name:DORMER, BERNARD J JR (DDS PA)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:J
Last Name:DORMER
Suffix:JR
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1410 S SALISBURY BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7127
Mailing Address - Country:US
Mailing Address - Phone:410-749-0248
Mailing Address - Fax:410-749-0292
Practice Address - Street 1:1410 S SALISBURY BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7127
Practice Address - Country:US
Practice Address - Phone:410-749-0248
Practice Address - Fax:410-749-0292
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD051561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
141236OtherUNITED CONCORDIAN
141236OtherUNITED CONCORDIAN
T78600Medicare UPIN