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General NPI Number Information
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NPI Number | 1538359112
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Entity Type | Organization
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Legal Business Name | BRENDAN BERNHART, DDS, PC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/30/2007
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Provider Practice Location Address
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Address Line | 3020 HAMAKER CT. STE. 510
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City | FAIRFAX
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State | VA
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Zip | 22031-2220
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Country | US
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Telephone | 703-645-8001
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Fax | 703-645-8002
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Provider Business Mailing Address
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Address Line | 3020 HAMAKER CT. STE. 510
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City | FAIRFAX
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State | VA
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Zip | 22031-2220
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Country | US
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Telephone | 703-645-8001
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Fax | 703-645-8002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRENDAN JOHN BERNHART
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Credential | D.D.S.
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Telephone | 703-645-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 0401410514
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License Number State | VA
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