Provider Demographics
NPI:1538129572
Name:BERMAN, MARTHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:RUBINSTEYN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6782 FAIRWINDS CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-9257
Mailing Address - Country:US
Mailing Address - Phone:818-522-8579
Mailing Address - Fax:
Practice Address - Street 1:3380 LA SIERRA AVE STE 108
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-5225
Practice Address - Country:US
Practice Address - Phone:951-354-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice