1780772038 NPI number — MR. JEFFREY M BERN DMD MAGD

Table of content: MR. JEFFREY M BERN DMD MAGD (NPI 1780772038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780772038 NPI number — MR. JEFFREY M BERN DMD MAGD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERN
Provider First Name:
JEFFREY
Provider Middle Name:
M
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DMD MAGD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780772038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2415 CENTRAL PARKWAY
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-409-9490
Provider Business Mailing Address Fax Number:
334-409-9492

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 CENTRAL PARKWAY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-409-9490
Provider Business Practice Location Address Fax Number:
334-409-9492
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3653 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 624734 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: MONALA . This is a "METLIFE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: JMBERN43 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: JMBERN43 . This is a "SOUTHLAND" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51090443 . This is a "BLUE CROSS BLUE SHILED" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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