Healthcare Provider Details

I. General information

NPI: 1346552767
Provider Name (Legal Business Name): KARL L. BIERDEMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KARL L. BIERDEMAN ORTHODONTICS, PA DMD

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 THOMASTOWN LN SUITE A
RIDGELAND MS
39157-3440
US

IV. Provider business mailing address

525 THOMASTOWN LN SUITE A
RIDGELAND MS
39157-3440
US

V. Phone/Fax

Practice location:
  • Phone: 601-856-3054
  • Fax: 601-856-5937
Mailing address:
  • Phone: 601-856-3054
  • Fax: 601-856-5937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20011518
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: