Healthcare Provider Details

I. General information

NPI: 1932329919
Provider Name (Legal Business Name): BRUCE ALLEN BERNSTEIN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4021 CENTRAL AVE
ST PETERSBURG FL
33713-8351
US

IV. Provider business mailing address

4021 CENTRAL AVE
ST PETERSBURG FL
33713-8351
US

V. Phone/Fax

Practice location:
  • Phone: 727-323-5200
  • Fax: 727-327-5919
Mailing address:
  • Phone: 727-323-5200
  • Fax: 727-327-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN0004742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: