Healthcare Provider Details

I. General information

NPI: 1114111598
Provider Name (Legal Business Name): ANA MARIA BERNARD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANA-MARIA DANIELA CIESIELSKI DDS

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 US 1 S SUITE 100
ST AUGUSTINE FL
32086-3708
US

IV. Provider business mailing address

1955 US 1 S SUITE 100
ST AUGUSTINE FL
32086-3708
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-5055
  • Fax: 904-825-6875
Mailing address:
  • Phone: 904-825-5055
  • Fax: 904-825-6875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010989A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberHAD 36
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: