Provider Demographics
NPI:1902510183
Name:JUSTIN CHRISTOPHER BERMAN, DMD, INC.
Entity Type:Organization
Organization Name:JUSTIN CHRISTOPHER BERMAN, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-351-9233
Mailing Address - Street 1:25425 ORCHARD VILLAGE RD STE 230
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2959
Mailing Address - Country:US
Mailing Address - Phone:661-259-2960
Mailing Address - Fax:
Practice Address - Street 1:25425 ORCHARD VILLAGE RD STE 230
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-2959
Practice Address - Country:US
Practice Address - Phone:661-259-2960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JUSTIN CHRISTOPHER BERMAN, DMD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770065963OtherNPI
CA102372OtherDENTAL BOARD OF CALIFORNIA