Healthcare Provider Details

I. General information

NPI: 1457541740
Provider Name (Legal Business Name): BERNHARDT & SMITH ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

9295 BISHOP DRIVE SUITE 120
WEST DES MOINES IA
50266
US

IV. Provider business mailing address

9295 BISHOP DRIVE SUITE 120
WEST DES MOINES IA
50266
US

V. Phone/Fax

Practice location:
  • Phone: 515-987-9130
  • Fax: 515-987-9133
Mailing address:
  • Phone: 515-987-9130
  • Fax: 515-987-9133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number07821
License Number StateIA

VIII. Authorized Official

Name: DR. MELISSA K BERNHARDT
Title or Position: PRESIDENT
Credential: DDS
Phone: 515-987-9130