Provider Demographics
NPI:1003910415
Name:BERMAN, STANLEY ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:ALAN
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5646
Mailing Address - Country:US
Mailing Address - Phone:440-842-2203
Mailing Address - Fax:440-842-3101
Practice Address - Street 1:6820 RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5646
Practice Address - Country:US
Practice Address - Phone:440-842-2203
Practice Address - Fax:440-842-3101
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300117521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0454772Medicare ID - Type Unspecified
OHT46155Medicare UPIN