Provider Demographics
NPI:1295997203
Name:BERNECKER, JAY MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:MICHAEL
Last Name:BERNECKER
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 1:103 W MAIN ST
Mailing Address - Street 2:PO BOX 253
Mailing Address - City:HARTINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68739-3005
Mailing Address - Country:US
Mailing Address - Phone:402-254-3969
Mailing Address - Fax:402-254-3977
Practice Address - Street 1:103 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTINGTON
Practice Address - State:NE
Practice Address - Zip Code:68739-3005
Practice Address - Country:US
Practice Address - Phone:402-254-3969
Practice Address - Fax:402-254-3977
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice