Individual
DR. BERNARD M EISEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
21 CENTER STREET, ANGOLA, NY 14006
(716) 549-3111
(716) 549-5667
Mailing address
21 CENTER STREET, ANGOLA, NY 14006
(716) 549-3111
(716) 549-5667
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0339421
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00620562
—
NY
Enumeration date
11/02/2005
Last updated
07/08/2007
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