Provider Demographics
NPI:1407414204
Name:BIERDEMAN, PATRICK CARY (DMD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:CARY
Last Name:BIERDEMAN
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 1:775 N BIERDEMAN RD
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-3300
Mailing Address - Country:US
Mailing Address - Phone:601-667-1198
Mailing Address - Fax:
Practice Address - Street 1:321 HIGHWAY 51 STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3404
Practice Address - Country:US
Practice Address - Phone:601-856-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4051-19122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist