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General NPI Number Information
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NPI Number | 1467004762
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Entity Type | Individual
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Provider Name | MARC ANTHONY BERNARDO DMD
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Gender | Male
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 1200 E WASHINGTON ST STE F2
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City | COLTON
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State | CA
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Zip | 92324-6499
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Country | US
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Telephone | 909-422-0885
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 668
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City | MORENO VALLEY
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State | CA
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Zip | 92556-0668
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Country | US
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Telephone | 951-242-6088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 104048
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License Number State | CA
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