=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629576608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALVAREZ & BERNARDO DENTAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2018
-----------------------------------------------------
Last Update Date | 01/25/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 E WASHINGTON ST STE F2
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-6499
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-422-0885
-----------------------------------------------------
Fax | 909-422-0890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 520
-----------------------------------------------------
City | COLTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92324-0520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-422-0885
-----------------------------------------------------
Fax | 909-422-0890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER/DENTIST
-----------------------------------------------------
Name | DR. SERAFIN LABAO BERNARDO JR.
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 909-422-0885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 37788
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------