Provider Demographics
NPI:1841367976
Name:TAINA, BERNARDO E (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:E
Last Name:TAINA
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 1:24015 SE KENT KANGLEY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-6802
Mailing Address - Country:US
Mailing Address - Phone:425-432-2753
Mailing Address - Fax:425-433-0600
Practice Address - Street 1:24015 SE KENT KANGLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-6802
Practice Address - Country:US
Practice Address - Phone:425-432-2753
Practice Address - Fax:425-433-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5047295Medicare ID - Type Unspecified