Provider Demographics
NPI:1811333412
Name:BERNARTZ, AMANDA (RDH)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:
Last Name:BERNARTZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2791
Mailing Address - Country:US
Mailing Address - Phone:860-291-9154
Mailing Address - Fax:860-291-9728
Practice Address - Street 1:15 MERCER AVE
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06118-1517
Practice Address - Country:US
Practice Address - Phone:860-622-5514
Practice Address - Fax:860-622-5513
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007372124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist