Healthcare Provider Details

I. General information

NPI: 1396043964
Provider Name (Legal Business Name): FRANK A BERMAN, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 PIERCE ST
KINGSTON PA
18704-5756
US

IV. Provider business mailing address

517 PIERCE ST
KINGSTON PA
18704-5756
US

V. Phone/Fax

Practice location:
  • Phone: 570-718-6000
  • Fax: 570-718-6666
Mailing address:
  • Phone: 570-718-6000
  • Fax: 570-718-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS022936L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDS022936L
License Number StatePA

VIII. Authorized Official

Name: DR. FRANK A BERMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 570-718-6000