Provider Demographics
NPI:1710252374
Name:BERNSTEIN, MELVIN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:D
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 1:1009WILLIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507
Mailing Address - Country:US
Mailing Address - Phone:516-747-2215
Mailing Address - Fax:516-747-2218
Practice Address - Street 1:1009 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1333
Practice Address - Country:US
Practice Address - Phone:516-747-2215
Practice Address - Fax:516-747-2218
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist