Provider Demographics
NPI:1801635610
Name:BERNAB, MORCOS (DMD)
Entity type:Individual
Prefix:DR
First Name:MORCOS
Middle Name:
Last Name:BERNAB
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 1:1309 LANCASTER LN
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-7581
Mailing Address - Country:US
Mailing Address - Phone:630-642-4405
Mailing Address - Fax:
Practice Address - Street 1:1309 LANCASTER LN
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-7581
Practice Address - Country:US
Practice Address - Phone:630-642-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035066122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist