Provider Demographics
NPI:1710921531
Name:GARY E. BERNER, DDS, PLLC
Entity Type:Organization
Organization Name:GARY E. BERNER, DDS, PLLC
Other - Org Name:HARBOR DENTAL GARY BERNER DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-679-3441
Mailing Address - Street 1:950 E. WHIDBEY AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2674
Mailing Address - Country:US
Mailing Address - Phone:360-679-3441
Mailing Address - Fax:360-240-0537
Practice Address - Street 1:950 E WHIDBEY AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2674
Practice Address - Country:US
Practice Address - Phone:360-679-3441
Practice Address - Fax:360-240-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA58171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5046735Medicaid