Provider Demographics
NPI:1114242575
Name:BERMAN, LOUISA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOUISA
Middle Name:S
Last Name:BERMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 WEST CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:587 VIRGINIA AVE NE
Practice Address - Street 2:SUITE 5
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3695
Practice Address - Country:US
Practice Address - Phone:404-433-3933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA124401223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics