Provider Demographics
NPI:1811454358
Name:BERMAN, CAROL (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:BERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 HIGHWAY 53 UNIT 162
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-1003
Mailing Address - Country:US
Mailing Address - Phone:706-654-6561
Mailing Address - Fax:
Practice Address - Street 1:4459 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-3704
Practice Address - Country:US
Practice Address - Phone:678-528-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0101121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice