Provider Demographics
NPI:1518326602
Name:ALVAREZ & BERNARDO DENTAL CORPORATION
Entity Type:Organization
Organization Name:ALVAREZ & BERNARDO DENTAL CORPORATION
Other - Org Name:ST. PATRICK DENTAL CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SERAFIN
Authorized Official - Middle Name:LABAO
Authorized Official - Last Name:BERNARDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-422-0885
Mailing Address - Street 1:P.O. BOX 520
Mailing Address - Street 2:1200 E. WASHINGTON ST., STE. F-2
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0520
Mailing Address - Country:US
Mailing Address - Phone:909-422-0885
Mailing Address - Fax:909-422-0890
Practice Address - Street 1:1200 E. WASHINGTON ST.
Practice Address - Street 2:STE. F-2
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-0520
Practice Address - Country:US
Practice Address - Phone:909-422-0885
Practice Address - Fax:909-422-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37788122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1134261480Medicaid