MEDICARE: ANDREW BERMAN, DDS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	16381	OH

General Provider Information

NPI Number	:	1063681989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANDREW BERMAN, DDS, INC

Provider Business Mailing Address
First Line	:	911 E AURORA RD
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-1905
Country	:	US
Telephone Number	:	330-467-1800
Fax Number	:	330-467-1811

Provider Business Practice Location Address
First Line	:	911 E AURORA RD
Second Line	:
City	:	MACEDONIA
State	:	OH
Zip	:	44056-1905
Country	:	US
Telephone Number	:	330-467-1800
Fax Number	:	330-467-1811

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. FANNY B LYONS
Credential	:
Telephone Number	:	330-467-1800

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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