Provider Demographics
NPI:1013093673
Name:BERNSTEIN, DUANE IRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:IRA
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141142
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32614-1142
Mailing Address - Country:US
Mailing Address - Phone:305-788-7297
Mailing Address - Fax:
Practice Address - Street 1:751 OAK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3359
Practice Address - Country:US
Practice Address - Phone:904-354-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN131341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics