Provider Demographics
NPI:1174695134
Name:BERNECKER, MICHAEL DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:BERNECKER
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 1:406 W LOCUST
Mailing Address - Street 2:PO BOX 238
Mailing Address - City:PLAINVIEW
Mailing Address - State:NE
Mailing Address - Zip Code:68769
Mailing Address - Country:US
Mailing Address - Phone:402-582-3344
Mailing Address - Fax:
Practice Address - Street 1:406 W LOCUST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NE
Practice Address - Zip Code:68769
Practice Address - Country:US
Practice Address - Phone:402-582-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077796800Medicaid