Provider Demographics
NPI:1487687281
Name:BERNARD J DORMER DDS PA
Entity Type:Organization
Organization Name:BERNARD J DORMER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR DORMER EMPLOYER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DORMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-749-0248
Mailing Address - Street 1:1410 S SALISBURY BLVD
Mailing Address - Street 2:STE 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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD051561223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
141236OtherUNITED CONCORDIA
T78600Medicare UPIN
141236OtherUNITED CONCORDIA