Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D10074 | OR |
NPI | 1003224718 |
---|---|
Provider Name | Dr. Andrew E Bernhard |
First Address | Klamath Falls, OR 97603-4603 |
Second Address | Klamath Falls, OR 97603-4603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2014 |
Last Update Date | 06/11/2017 |