Provider Demographics
NPI:1700967502
Name:BERNIE, ROBERT DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:BERNIE
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 1:1855 OLYMPIC BLVD
Mailing Address - Street 2:#360
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5069
Mailing Address - Country:US
Mailing Address - Phone:925-934-4011
Mailing Address - Fax:925-934-0851
Practice Address - Street 1:1855 OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5069
Practice Address - Country:US
Practice Address - Phone:925-934-4011
Practice Address - Fax:925-934-0851
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA330211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics