Provider Demographics
NPI:1740578012
Name:BERNSTEIN, ETTA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ETTA
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NEW HACKENSACK RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-1325
Mailing Address - Country:US
Mailing Address - Phone:845-297-9959
Mailing Address - Fax:
Practice Address - Street 1:11 NEW HACKENSACK RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-1325
Practice Address - Country:US
Practice Address - Phone:845-297-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0560561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice