Provider Demographics
NPI:1760876270
Name:BERNARD, ANGELA (RDH)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:BERNARD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14164 ABINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1304
Mailing Address - Country:US
Mailing Address - Phone:313-837-5839
Mailing Address - Fax:313-837-5839
Practice Address - Street 1:14164 ABINGTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1304
Practice Address - Country:US
Practice Address - Phone:313-837-5839
Practice Address - Fax:313-837-5839
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902011668124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist