Provider Demographics
NPI:1992144802
Name:BERMAN, BRANDON MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MATTHEW
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 1:7131 ARLINGTON RD
Mailing Address - Street 2:APT 402
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2903
Mailing Address - Country:US
Mailing Address - Phone:301-910-1455
Mailing Address - Fax:
Practice Address - Street 1:7131 ARLINGTON RD
Practice Address - Street 2:APT 402
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2903
Practice Address - Country:US
Practice Address - Phone:301-910-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
MD154861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program