Healthcare Provider Details

I. General information

NPI: 1073732053
Provider Name (Legal Business Name): SHAWNA G. BERNDT D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 03/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 DENVER AVE
FORT LUPTON CO
80621-1819
US

IV. Provider business mailing address

229 DENVER AVE
FORT LUPTON CO
80621-1819
US

V. Phone/Fax

Practice location:
  • Phone: 303-857-4377
  • Fax: 303-857-1533
Mailing address:
  • Phone: 303-857-4377
  • Fax: 303-857-1533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8634
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: