Healthcare Provider Details

I. General information

NPI: 1710057146
Provider Name (Legal Business Name): SHERI LYNN BERNADETT DDS MSCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 PROVIDENCE MINE RD #211
NEVADA CITY CA
95959
US

IV. Provider business mailing address

204 PROVIDENCE MINE RD #211
NEVADA CITY CA
95959
US

V. Phone/Fax

Practice location:
  • Phone: 530-265-4002
  • Fax: 530-265-7901
Mailing address:
  • Phone: 530-265-4002
  • Fax: 530-265-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number39756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: