Provider Demographics
NPI:1134573462
Name:ISORDIA BERNES, MARYAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:ISORDIA BERNES
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 1:1245 MORNING VIEW DR
Mailing Address - Street 2:330
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3425
Mailing Address - Country:US
Mailing Address - Phone:760-626-5835
Mailing Address - Fax:
Practice Address - Street 1:1286B AUTO PARK WAY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-2232
Practice Address - Country:US
Practice Address - Phone:760-705-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-23
Last Update Date:2016-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist