Provider Demographics
NPI:1265518617
Name:BERNARD, JO ANNE M (DDS)
Entity type:Individual
Prefix:DR
First Name:JO ANNE
Middle Name:M
Last Name:BERNARD
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 1:2411 CROFTON LANE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114
Mailing Address - Country:US
Mailing Address - Phone:301-261-3993
Mailing Address - Fax:410-721-4985
Practice Address - Street 1:2411 CROFTON LANE
Practice Address - Street 2:SUITE 6
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114
Practice Address - Country:US
Practice Address - Phone:301-261-3993
Practice Address - Fax:410-721-4985
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist