Provider Demographics
NPI:1083454391
Name:BEMRI, NEDRA (DMD)
Entity type:Individual
Prefix:
First Name:NEDRA
Middle Name:
Last Name:BEMRI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 INGERSOLL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-5013
Mailing Address - Country:US
Mailing Address - Phone:267-351-0875
Mailing Address - Fax:
Practice Address - Street 1:404 MIDDLETOWN BLVD STE 300
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1897
Practice Address - Country:US
Practice Address - Phone:215-757-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044576122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist