Provider Demographics
NPI:1790806891
Name:BERNER, CAROL DENISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:DENISE
Last Name:BERNER
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 1:454 4TH ST W
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6531
Mailing Address - Country:US
Mailing Address - Phone:707-996-3737
Mailing Address - Fax:707-996-8840
Practice Address - Street 1:454 4TH ST W
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6531
Practice Address - Country:US
Practice Address - Phone:707-996-3737
Practice Address - Fax:707-996-8840
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice