Provider Demographics
NPI:1306848320
Name:BERMAN, ANDREW N (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:N
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 1:911 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:
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:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0519371Medicaid
OH0519371Medicaid
OHT47964Medicare UPIN
OHBE0541253Medicare ID - Type Unspecified