Provider Demographics
NPI:1790778355
Name:BERNARD J DENNISON JR DDS PA
Entity Type:Organization
Organization Name:BERNARD J DENNISON JR DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DENNISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-944-2383
Mailing Address - Street 1:908 N SANDHILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-2547
Mailing Address - Country:US
Mailing Address - Phone:910-944-2383
Mailing Address - Fax:910-944-9334
Practice Address - Street 1:908 N SANDHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2547
Practice Address - Country:US
Practice Address - Phone:910-944-2383
Practice Address - Fax:910-944-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty