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Organization
USA DENTAC
Active
Organization
USA DENTAC
Active
Parent organization
123456
Organization subpart
Yes
Provider details
NPI number
Legal business name
123456
Authorized official
CHARLES BERNATOVITZ BSD (HSS)
(910) 643-2196
Entity
Organization
Contact information
Practice address
2817 REILLY ST, FORT BRAGG, NC 28310-7324
(910) 643-2196
Mailing address
2817 RIELLY ROAD, FORT BRAGG, NC 28310
(910) 643-2196
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
7547
NC
Other
Enumeration date
08/31/2016
Last updated
08/31/2016
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