Provider Demographics
NPI:1568913424
Name:DR. MILTON D. BERNARD DDS PC
Entity Type:Organization
Organization Name:DR. MILTON D. BERNARD DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:DESMOND
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-291-2974
Mailing Address - Street 1:7826 EASTERN AVE NW
Mailing Address - Street 2:SUITE #405
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1324
Mailing Address - Country:US
Mailing Address - Phone:202-291-2974
Mailing Address - Fax:202-722-4551
Practice Address - Street 1:7826 EASTERN AVE NW
Practice Address - Street 2:SUITE #405
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1324
Practice Address - Country:US
Practice Address - Phone:202-291-2974
Practice Address - Fax:202-722-4551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC25961223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC179301OtherMEDICARE
DC0216604500Medicaid