Provider Demographics
NPI:1558476705
Name:BERMAN, GREGORY JAY (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAY
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11458 NAPOLSKE CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3326
Mailing Address - Country:US
Mailing Address - Phone:248-229-7387
Mailing Address - Fax:
Practice Address - Street 1:1971 NORTH ZARAGOZA ROAD BUILDING A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938
Practice Address - Country:US
Practice Address - Phone:248-229-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010190301223G0001X
NMDD33571223X0400X
TX258351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice