Provider Demographics
NPI:1871715722
Name:BERNSTEIN, EUGENE (DDS)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 FERRY ST
Mailing Address - Street 2:SUITE B 2
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-3475
Mailing Address - Country:US
Mailing Address - Phone:973-817-8888
Mailing Address - Fax:973-465-1955
Practice Address - Street 1:290 FERRY ST
Practice Address - Street 2:SUITE B 2
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-3475
Practice Address - Country:US
Practice Address - Phone:973-817-8888
Practice Address - Fax:973-465-1955
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02099201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist