Healthcare Provider Details

I. General information

NPI: 1306848320
Provider Name (Legal Business Name): ANDREW N BERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 E AURORA RD
MACEDONIA OH
44056-1905
US

IV. Provider business mailing address

911 E AURORA RD
MACEDONIA OH
44056-1905
US

V. Phone/Fax

Practice location:
  • Phone: 330-467-1800
  • Fax:
Mailing address:
  • Phone: 330-467-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number16381
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: