Provider Demographics
NPI:1952325136
Name:BERNIKER, RICHARD LESLIE (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LESLIE
Last Name:BERNIKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PORTION RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4587
Mailing Address - Country:US
Mailing Address - Phone:631-471-4500
Mailing Address - Fax:631-471-0609
Practice Address - Street 1:500 PORTION RD
Practice Address - Street 2:SUITE 3
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4587
Practice Address - Country:US
Practice Address - Phone:631-471-4500
Practice Address - Fax:631-471-0609
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0373891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice