Provider Demographics
NPI:1245437102
Name:BERNAL, DAVID P (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:BERNAL
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 1:7675 MEMORIAL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2015
Mailing Address - Country:US
Mailing Address - Phone:409-853-3100
Mailing Address - Fax:
Practice Address - Street 1:7675 MEMORIAL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2015
Practice Address - Country:US
Practice Address - Phone:409-853-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice