Provider Demographics
NPI:1366601189
Name:BERNABE GENERAL DENTISTRY PC
Entity type:Organization
Organization Name:BERNABE GENERAL DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:BOLIVAR
Authorized Official - Last Name:BERNABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-716-1400
Mailing Address - Street 1:1916 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5201
Mailing Address - Country:US
Mailing Address - Phone:718-716-1400
Mailing Address - Fax:718-716-7025
Practice Address - Street 1:1916 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5201
Practice Address - Country:US
Practice Address - Phone:718-716-1400
Practice Address - Fax:718-716-7025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01277687Medicaid