Provider Demographics
NPI:1114940020
Name:BERMAN, MARVIN STEPHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:STEPHEN
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 ROUND BARN BLVD APT 306
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-0143
Mailing Address - Country:US
Mailing Address - Phone:707-892-1744
Mailing Address - Fax:
Practice Address - Street 1:3585 ROUND BARN BLVD APT 306
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-0143
Practice Address - Country:US
Practice Address - Phone:707-892-1744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033879122300000X
NY033879-11223G0001X
CA1069971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist