Provider Demographics
NPI:1609170299
Name:BERNIER, DAVID ENRIQUE (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ENRIQUE
Last Name:BERNIER
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:PMB 491
Mailing Address - Street 2:1353 AVE. LUIS VIGOREAUX
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-598-1778
Mailing Address - Fax:
Practice Address - Street 1:1353 AVE LUIS VIGOREAUX
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2715
Practice Address - Country:US
Practice Address - Phone:787-598-1778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR002651OtherNUMERO DE LICENCIA