Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 0401004974 | VA |
NPI | 1073604765 |
---|---|
Provider Name | Dr. Elizabeth Ann Bernhard |
First Address | Smithfield, VA 23430-1134 |
Second Address | Smithfield, VA 23430-1134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 08/07/2007 |