Provider Demographics
NPI:1063681989
Name:ANDREW BERMAN, DDS, INC
Entity Type:Organization
Organization Name:ANDREW BERMAN, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FANNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-467-1800
Mailing Address - Street 1:911 E AURORA RD
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1905
Mailing Address - Country:US
Mailing Address - Phone:330-467-1800
Mailing Address - Fax:330-467-1811
Practice Address - Street 1:911 E AURORA RD
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1905
Practice Address - Country:US
Practice Address - Phone:330-467-1800
Practice Address - Fax:330-467-1811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9327941Medicare PIN