Provider Demographics
NPI:1336572791
Name:BERNARD, TODD (DMD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:BERNARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37701 COLORADO AVE STE E
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2841
Mailing Address - Country:US
Mailing Address - Phone:440-934-2600
Mailing Address - Fax:440-934-2602
Practice Address - Street 1:37701 COLORADO AVE STE E
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011
Practice Address - Country:US
Practice Address - Phone:440-934-2600
Practice Address - Fax:440-934-2602
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0240581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry