Healthcare Provider Details

I. General information

NPI: 1063436574
Provider Name (Legal Business Name): JACK D BERNS DDS & ANTHONY T DIOGUARDI DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 YORK ST SUITE 2J
NEW HAVEN CT
06511-5614
US

IV. Provider business mailing address

123 YORK ST SUITE 2J
NEW HAVEN CT
06511-5614
US

V. Phone/Fax

Practice location:
  • Phone: 203-777-2513
  • Fax: 203-776-1714
Mailing address:
  • Phone: 203-777-2513
  • Fax: 203-776-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number6446
License Number StateCT

VIII. Authorized Official

Name: DR. ANTHONY THOMAS DIOGUARDI
Title or Position: OWNER/PARTNER
Credential:
Phone: 203-777-2513