Provider Demographics
NPI:1770100372
Name:SARKIS, BERNARD MARIO (DMD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:MARIO
Last Name:SARKIS
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 1:1471 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-3026
Mailing Address - Country:US
Mailing Address - Phone:617-763-3394
Mailing Address - Fax:
Practice Address - Street 1:100 S ELLSWORTH AVE STE 601
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3928
Practice Address - Country:US
Practice Address - Phone:650-342-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-30
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858718122300000X
CA107219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist