Provider Demographics
NPI:1245458371
Name:BERNHART, BRENDAN JOHN (DDS)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:JOHN
Last Name:BERNHART
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 1:2140 WOLFTRAP CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5188
Mailing Address - Country:US
Mailing Address - Phone:703-698-1232
Mailing Address - Fax:
Practice Address - Street 1:3020 HAMAKER CT
Practice Address - Street 2:SUITE 510
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2238
Practice Address - Country:US
Practice Address - Phone:703-645-8001
Practice Address - Fax:703-645-8002
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4105141223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01905B01Medicare ID - Type Unspecified
VAV04290Medicare UPIN