Provider Demographics
NPI:1528191459
Name:M.MINCER DDS & H.BERMAN DMD
Entity Type:Organization
Organization Name:M.MINCER DDS & H.BERMAN DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-356-5660
Mailing Address - Street 1:3536 RHOADS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3702
Mailing Address - Country:US
Mailing Address - Phone:610-356-5660
Mailing Address - Fax:610-356-1902
Practice Address - Street 1:3536 RHOADS AVE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3702
Practice Address - Country:US
Practice Address - Phone:610-356-5660
Practice Address - Fax:610-356-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA879781OtherUNITED CONCORDIA PROVIDER