Provider Demographics
NPI:1538664156
Name:BRASILEIRO, BERNARDO FERREIRA (DDS, MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:FERREIRA
Last Name:BRASILEIRO
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4383 WATERCOLOR WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1171
Mailing Address - Country:US
Mailing Address - Phone:859-494-0231
Mailing Address - Fax:
Practice Address - Street 1:8267 COLLEGE PKWY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5193
Practice Address - Country:US
Practice Address - Phone:239-936-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN254791223S0112X
MS4181-21122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery