Provider Demographics
NPI:1598838989
Name:NORTH CHAUTAUQUA DENTAL GROUP PC
Entity Type:Organization
Organization Name:NORTH CHAUTAUQUA DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-366-6822
Mailing Address - Street 1:744 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2505
Mailing Address - Country:US
Mailing Address - Phone:716-366-6822
Mailing Address - Fax:716-366-4055
Practice Address - Street 1:744 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2505
Practice Address - Country:US
Practice Address - Phone:716-366-6822
Practice Address - Fax:716-366-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0336041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherFEDERAL TAX ID NUMBER