Provider Demographics
NPI:1598841058
Name:BIERNACKI, JOHN F (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:BIERNACKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 NATE WHIPPLE HIGHWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-658-2224
Mailing Address - Fax:401-658-0039
Practice Address - Street 1:175 NATE WHIPPLE HIGHWAY
Practice Address - Street 2:SUITE 210
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-658-2224
Practice Address - Fax:401-658-0039
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI016141223S0112X
MA0121001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI86509OtherBCBS
MAX04251OtherBCBS
MAX04251OtherBCBS
007001570Medicare ID - Type Unspecified
RI86509OtherBCBS