Provider Demographics
NPI:1811956253
Name:BOMBERG, BERNARD L (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:L
Last Name:BOMBERG
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 1:1651 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2227
Mailing Address - Country:US
Mailing Address - Phone:651-645-4759
Mailing Address - Fax:
Practice Address - Street 1:604 SNELLING AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1528
Practice Address - Country:US
Practice Address - Phone:651-699-5600
Practice Address - Fax:651-699-1966
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN76621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice