Provider Demographics
NPI:1659321495
Name:BERNSTEIN, MARK L (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:BERNSTEIN
Suffix:
Gender:M
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:DEPT. OF SURGICAL AND HOSPITAL DENTISTRY
Mailing Address - Street 2:UNIVERSITY OF LOUISVILLE SCHOOL OF DENTISTRY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40292-0001
Mailing Address - Country:US
Mailing Address - Phone:502-852-5083
Mailing Address - Fax:502-852-5988
Practice Address - Street 1:501 S PRESTON ST
Practice Address - Street 2:SCHOOL OF DENTISTRY, SUITE 334
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292-0001
Practice Address - Country:US
Practice Address - Phone:502-852-5083
Practice Address - Fax:502-852-5988
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48071223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4013501OtherORAL PATH MEDICARE PIN
KY50015221OtherPASSPORT HEALTH PLAN
KYW01743OtherORAL PATH LAB UPIN
KY000000311546OtherANTHEM BC BS
KY60003381Medicaid
KY9178936OtherDORAL DENTAL
KYT53934Medicare UPIN
KY4013501OtherORAL PATH MEDICARE PIN