Provider Demographics
NPI:1356556476
Name:DEBERNARDIS, TERESA ANITA (DMD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANITA
Last Name:DEBERNARDIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 2ND ST PIKE
Mailing Address - Street 2:A
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3951
Mailing Address - Country:US
Mailing Address - Phone:215-357-0511
Mailing Address - Fax:
Practice Address - Street 1:816 2ND ST PIKE
Practice Address - Street 2:A
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3951
Practice Address - Country:US
Practice Address - Phone:215-357-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025556L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice