Provider Demographics
NPI:1831670090
Name:RAEL BERNSTEIN DDS APC
Entity Type:Organization
Organization Name:RAEL BERNSTEIN DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-230-5602
Mailing Address - Street 1:2245 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4900
Mailing Address - Country:US
Mailing Address - Phone:707-230-5602
Mailing Address - Fax:707-230-5620
Practice Address - Street 1:1600 N PARK BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565
Practice Address - Country:US
Practice Address - Phone:707-575-0600
Practice Address - Fax:707-230-5620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAEL BERNSTEIN, D.D.S., A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-27
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty