Provider Demographics
NPI:1467017947
Name:RAEL BERNSTEIN D.D.S., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:RAEL BERNSTEIN D.D.S., A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-230-5602
Mailing Address - Street 1:2180 NORTHPOINT PKWY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-7395
Mailing Address - Country:US
Mailing Address - Phone:707-230-5602
Mailing Address - Fax:707-230-5620
Practice Address - Street 1:741 FRONT ST
Practice Address - Street 2:
Practice Address - City:SOLEDAD
Practice Address - State:CA
Practice Address - Zip Code:93960-3017
Practice Address - Country:US
Practice Address - Phone:707-575-0600
Practice Address - Fax:707-230-5620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BERNSTEIN ORTHODONTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty