Individual provider Active NPI

Hector Bolivar Bernabe, DDS

  • General Practice Dentistry
  • Bronx, NY
National Provider Identifier
1104815406
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
043696 Issued in NY
Practice address
1916 Grand Concourse
Bronx, NY 10457-5201
Phone
(718) 716-1400
Fax
(718) 716-7025
NPI assigned
Oct 19, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 043696 NY Primary

Addresses

Primary practice location

1916 Grand Concourse
Bronx, NY 10457-5201

Mailing address

1916 Grand Concourse
Bronx, NY 10457-5201
Phone (718) 716-1400

Other identifiers 1

IdentifierTypeStateIssuer
01277687MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230605000457 NY Practitioner - Oral SurgeryPractitioner - Dentist 2668778127 Reassigns benefits to 5 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
3545 Johnson Blvd Dental PC CurrentSince Apr 26, 2023 Accepting new patients
43 Chruch Street Dental PC CurrentSince Apr 26, 2023 Accepting new patients
Alejandro Williams Dental Office PC CurrentSince Apr 26, 2023 Accepting new patients
Bonita Sonrisa Dental Ipa CurrentSince Apr 26, 2023 Accepting new patients
Bonita Sonrisa Dental Mso CurrentSince Apr 26, 2023 Accepting new patients
Spore Test Inc CurrentSince Apr 26, 2023 Accepting new patients

Locations

759 4th Ave
Brooklyn, NY 11232
Phone (718) 832-1194

1810 Harriet St
Elmont, NY 11003
Phone (516) 354-3371

664 Academy St
New York, NY 10034
Phone (212) 567-2431

736 W 181st St
Apt 1I
New York, NY 10033
Phone (347) 681-1800

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1104815406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1916 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104575201",
            "telephone_number": "718-716-1400",
            "fax_number": "718-716-7025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1916 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104575201",
            "telephone_number": "718-716-1400",
            "fax_number": "718-716-7025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNABE",
        "first_name": "HECTOR",
        "middle_name": "BOLIVAR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "043696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01277687",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.