Provider Demographics
NPI:1912049263
Name:BERNARDO, SERAFIN LABAO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERAFIN
Middle Name:LABAO
Last Name:BERNARDO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:24655 SUNNYMEAD BLVD
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92556-0668
Mailing Address - Country:US
Mailing Address - Phone:951-242-6088
Mailing Address - Fax:951-242-5050
Practice Address - Street 1:24655 SUNNYMEAD BLVD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92556
Practice Address - Country:US
Practice Address - Phone:951-242-6088
Practice Address - Fax:951-242-5050
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA377881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice