Provider Demographics
NPI:1407036833
Name:R. MATTHEW BEREMAN, DDS, PA
Entity Type:Organization
Organization Name:R. MATTHEW BEREMAN, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BEREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-850-2065
Mailing Address - Street 1:807 SPRING FOREST RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-9114
Mailing Address - Country:US
Mailing Address - Phone:919-850-2065
Mailing Address - Fax:919-876-5010
Practice Address - Street 1:807 SPRING FOREST RD STE 1500
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-9114
Practice Address - Country:US
Practice Address - Phone:919-850-2065
Practice Address - Fax:919-876-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty