Provider Demographics
NPI:1770705485
Name:BEREZANSKY, THOMAS PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:BEREZANSKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 LINCOLN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3549
Mailing Address - Country:US
Mailing Address - Phone:412-761-1972
Mailing Address - Fax:412-761-1880
Practice Address - Street 1:555 LINCOLN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3549
Practice Address - Country:US
Practice Address - Phone:412-761-1972
Practice Address - Fax:412-761-1880
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030444L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA275778OtherUNITED CONCORDIA ID