MEDICARE: BERNABE GENERAL DENTISTRY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	043696	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366601189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERNABE GENERAL DENTISTRY PC

Provider Business Mailing Address
First Line	:	1916 GRAND CONCOURSE
Second Line	:	SUITE 1A
City	:	BRONX
State	:	NY
Zip	:	10457-5201
Country	:	US
Telephone Number	:	718-716-1400
Fax Number	:	718-716-7025

Provider Business Practice Location Address
First Line	:	1916 GRAND CONCOURSE
Second Line	:	SUITE 1A
City	:	BRONX
State	:	NY
Zip	:	10457-5201
Country	:	US
Telephone Number	:	718-716-1400
Fax Number	:	718-716-7025

Authorized Official
Title or Position	:	DENTIST/PRESIDENT
Name	:	DR. HECTOR BOLIVAR BERNABE
Credential	:	D.D.S.
Telephone Number	:	718-716-1400

Provider Enumeration Date	:	06/06/2008
Last Update Date	:	06/06/2008

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