Provider Demographics
NPI:1265957351
Name:BERMAN, JUSTIN CHRISTOPHER (DMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:CHRISTOPHER
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 1:5020 KLUMP AVE APT 415
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-5045
Mailing Address - Country:US
Mailing Address - Phone:786-351-9233
Mailing Address - Fax:
Practice Address - Street 1:23838 VALENCIA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5334
Practice Address - Country:US
Practice Address - Phone:661-259-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1018811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry