Healthcare Provider Details

I. General information

NPI: 1013093673
Provider Name (Legal Business Name): DUANE IRA BERNSTEIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 OAK ST
JACKSONVILLE FL
32204-3359
US

IV. Provider business mailing address

PO BOX 141142
GAINESVILLE FL
32614-1142
US

V. Phone/Fax

Practice location:
  • Phone: 904-354-4031
  • Fax:
Mailing address:
  • Phone: 305-788-7297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN13134
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: