Provider Demographics
NPI:1871753004
Name:BERNABE, HECTOR CHRISTIAN (RDH)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:CHRISTIAN
Last Name:BERNABE
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2903
Mailing Address - Country:US
Mailing Address - Phone:201-522-8193
Mailing Address - Fax:
Practice Address - Street 1:1916 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5201
Practice Address - Country:US
Practice Address - Phone:718-716-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024141124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY024141OtherDENTAL HYGIENE LICENSE