Provider Demographics
NPI:1497870620
Name:BERMAN, GARY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
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 1:28 PINE RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1622
Mailing Address - Country:US
Mailing Address - Phone:860-423-2004
Mailing Address - Fax:
Practice Address - Street 1:720 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2604
Practice Address - Country:US
Practice Address - Phone:860-423-5518
Practice Address - Fax:860-456-1617
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT50051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice