Provider Demographics
NPI:1508103219
Name:RAEL BERNSTEIN DDS APC
Entity Type:Organization
Organization Name:RAEL BERNSTEIN DDS APC
Other - Org Name:WOW SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAEL
Authorized Official - Middle Name:ILAN
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:707-575-0600
Mailing Address - Street 1:1620 VALLE VISTA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589
Mailing Address - Country:US
Mailing Address - Phone:707-575-0600
Mailing Address - Fax:
Practice Address - Street 1:1620 VALLE VISTA AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589
Practice Address - Country:US
Practice Address - Phone:707-575-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-15
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty