Individual
DR. BERNARDO FAUSTO BIANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1601 SW ARCHER RD, GAINESVILLE, FL 32608-1135
(352) 548-6000
Mailing address
1382 N LOOP PKWY, ST AUGUSTINE, FL 32095-4865
(321) 663-3119
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DNO13805
GA
1223P0300X
Periodontics
DN013805
GA
1223P0300X
Periodontics
Primary
DN22812
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN22812
DENTAL LICENSE NUMBER
FL
Enumeration date
10/08/2008
Last updated
06/30/2022
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