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General NPI Number Information
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NPI Number | 1538299300
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Entity Type | Individual
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Provider Name | BERNIDA LUCILE IQBAL DDS
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 498 NW 18TH ST
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City | RICHMOND
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State | IN
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Zip | 47374-2851
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Country | US
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Telephone | 765-914-1934
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Fax |
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Provider Business Mailing Address
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Address Line | 104 CHURCH ROCK PL
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City | GALLUP
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State | NM
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Zip | 87301-4511
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Country | US
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Telephone | 765-914-1934
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12007350A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 12007350A
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License Number State | IN
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