MEDICARE: DAVID BEN BERNARD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	6105	CT
2	1223G0001X	General Practice Dentistry	6105	CT

General Provider Information

NPI Number	:	1912048042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID BEN BERNARD D.D.S.

Provider Business Mailing Address
First Line	:	33 LEXINGTON ST
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06052-1446
Country	:	US
Telephone Number	:	860-229-3084
Fax Number	:	860-826-8097

Provider Business Practice Location Address
First Line	:	33 LEXINGTON ST
Second Line	:
City	:	NEW BRITAIN
State	:	CT
Zip	:	06052-1446
Country	:	US
Telephone Number	:	860-229-3084
Fax Number	:	860-826-8097

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2007
Last Update Date	:	12/06/2012

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Directions to “ DAVID BEN BERNARD D.D.S.” Practice Location

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