Provider Demographics
NPI:1346552767
Name:BIERDEMAN, KARL L (DMD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:L
Last Name:BIERDEMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:KARL
Other - Middle Name:L
Other - Last Name:BIERDEMAN ORTHODONTICS, PA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:525 THOMASTOWN LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3440
Mailing Address - Country:US
Mailing Address - Phone:601-856-3054
Mailing Address - Fax:601-856-5937
Practice Address - Street 1:525 THOMASTOWN LN
Practice Address - Street 2:SUITE A
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3440
Practice Address - Country:US
Practice Address - Phone:601-856-3054
Practice Address - Fax:601-856-5937
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS200115181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics