Provider Demographics
NPI:1780772038
Name:BERN, JEFFREY M (DMD MAGD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:BERN
Suffix:
Gender:M
Credentials:DMD MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 CENTRAL PARKWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-409-9490
Mailing Address - Fax:334-409-9492
Practice Address - Street 1:2415 CENTRAL PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-409-9490
Practice Address - Fax:334-409-9492
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL624734OtherUNITED CONCORDIA
ALMONALAOtherMETLIFE
ALJMBERN43OtherCIGNA
ALJMBERN43OtherSOUTHLAND
AL51090443OtherBLUE CROSS BLUE SHILED