Provider Demographics
NPI:1609984533
Name:FRENCH, BERNARD D
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:D
Last Name:FRENCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-0503
Mailing Address - Country:US
Mailing Address - Phone:860-739-3401
Mailing Address - Fax:860-739-9750
Practice Address - Street 1:177 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1203
Practice Address - Country:US
Practice Address - Phone:860-739-3401
Practice Address - Fax:860-739-9750
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT57191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU32620Medicare UPIN