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NPI Code Detail

MEDICARE: MARTIN RANDALL BERST DDS

MEDICARE:   MARTIN RANDALL BERST  DDS
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
11223G0001XGeneral Practice Dentistry7823IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487741732
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTIN RANDALL BERST DDS
Provider Business Mailing Address
First Line : 4900 N RIVER BLVD NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52411
Country : US
Telephone Number : 319-247-7008
Fax Number : 319-378-0937
Provider Business Practice Location Address
First Line : 4900 N RIVER BLVD NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52411
Country : US
Telephone Number : 319-247-7008
Fax Number : 319-378-0937
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 07/08/2007

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Directions to “ MARTIN RANDALL BERST DDS” Practice Location

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