Healthcare Provider Details

I. General information

NPI: 1992905186
Provider Name (Legal Business Name): SVETLANA BERMAN D.D.S., M.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 ADAMS ST SUITE D
CARMEL IN
46032-7541
US

IV. Provider business mailing address

704 ADAMS ST SUITE D
CARMEL IN
46032-7541
US

V. Phone/Fax

Practice location:
  • Phone: 317-815-5552
  • Fax: 317-815-5571
Mailing address:
  • Phone: 317-815-5552
  • Fax: 317-815-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12010665A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: