Provider Demographics
NPI:1891964813
Name:BERMAN ENDODONTICS, LLC
Entity Type:Organization
Organization Name:BERMAN ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:317-867-4141
Mailing Address - Street 1:16407 SOUTHPARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8473
Mailing Address - Country:US
Mailing Address - Phone:317-867-4141
Mailing Address - Fax:317-867-4033
Practice Address - Street 1:16407 SOUTHPARK DR STE B
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8473
Practice Address - Country:US
Practice Address - Phone:317-867-4141
Practice Address - Fax:317-867-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-24
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010665A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental