Provider Demographics
NPI:1811998966
Name:BERMAN, BARRY RONALD (DDS)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:RONALD
Last Name:BERMAN
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 1:110 PAINTERS MILL RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4920
Mailing Address - Country:US
Mailing Address - Phone:410-363-4422
Mailing Address - Fax:410-581-1825
Practice Address - Street 1:110 PAINTERS MILL RD
Practice Address - Street 2:SUITE 8
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4920
Practice Address - Country:US
Practice Address - Phone:410-363-4422
Practice Address - Fax:410-581-1825
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4790204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD45061000Medicaid
MD45061000Medicaid
T59701Medicare UPIN