Provider Demographics
NPI:1912031105
Name:IGNACIO Z. BERNARDO JR., D.D.S., INC.
Entity Type:Organization
Organization Name:IGNACIO Z. BERNARDO JR., D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BERNARDO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-346-0637
Mailing Address - Street 1:1031 QUARRIER ST
Mailing Address - Street 2:SUITE 301 ATLAS BUILDING
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2317
Mailing Address - Country:US
Mailing Address - Phone:304-346-0637
Mailing Address - Fax:
Practice Address - Street 1:1031 QUARRIER ST
Practice Address - Street 2:SUITE 301 ATLAS BUILDING
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2317
Practice Address - Country:US
Practice Address - Phone:304-346-0637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7800012000Medicaid