MEDICARE: MARK A LERMAN DMD

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)	21698	MA
2	1223P0106X	Oral and Maxillofacial Pathology Dentistry	21698	MA

General Provider Information

NPI Number	:	1295819217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A LERMAN DMD

Provider Business Mailing Address
First Line	:	1 KNEELAND ST RM 646
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02111-1527
Country	:	US
Telephone Number	:	617-636-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 KNEELAND ST RM 646
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02111-1527
Country	:	US
Telephone Number	:	617-636-6510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/30/2020

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Directions to “ MARK A LERMAN DMD” Practice Location

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