Provider Demographics
NPI:1134758337
Name:BERNAL, CATHERINE JOHANNA DENNIS (DO)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:JOHANNA DENNIS
Last Name:BERNAL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:JOHANNA
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4481 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45433-5536
Mailing Address - Country:US
Mailing Address - Phone:937-522-4784
Mailing Address - Fax:
Practice Address - Street 1:4481 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45433-5536
Practice Address - Country:US
Practice Address - Phone:937-522-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT8765208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics