Provider Demographics
NPI:1578658332
Name:FRIAS, BERNARDA I (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERNARDA
Middle Name:I
Last Name:FRIAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5972 JAKE SEARS CIR APT 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5123
Mailing Address - Country:US
Mailing Address - Phone:561-427-5076
Mailing Address - Fax:
Practice Address - Street 1:4107 PORTSMOUTH BLVD
Practice Address - Street 2:SUITE #107
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2140
Practice Address - Country:US
Practice Address - Phone:757-488-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414445122300000X
FLDN16164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist