Healthcare Provider Details

I. General information

NPI: 1538299300
Provider Name (Legal Business Name): BERNIDA LUCILE IQBAL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

498 NW 18TH ST
RICHMOND IN
47374-2851
US

IV. Provider business mailing address

104 CHURCH ROCK PL
GALLUP NM
87301-4511
US

V. Phone/Fax

Practice location:
  • Phone: 765-914-1934
  • Fax:
Mailing address:
  • Phone: 765-914-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12007350A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number12007350A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: