Provider Demographics
NPI:1366730236
Name:BERNKRANT, SHANNA SARAH (DMD)
Entity type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:SARAH
Last Name:BERNKRANT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12404 W DIXIE HWY
Mailing Address - Street 2:NORTH MIAMI
Mailing Address - City:FL
Mailing Address - State:FL
Mailing Address - Zip Code:33161
Mailing Address - Country:US
Mailing Address - Phone:305-893-4801
Mailing Address - Fax:
Practice Address - Street 1:12404 W DIXIE HWY
Practice Address - Street 2:NORTH MIAMI
Practice Address - City:FL
Practice Address - State:FL
Practice Address - Zip Code:33161
Practice Address - Country:US
Practice Address - Phone:305-893-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19628122300000X
TXETN4390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program