Provider Demographics
NPI:1265433692
Name:BERMAN, SCOTT CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:CRAIG
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 1:311 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046
Mailing Address - Country:US
Mailing Address - Phone:703-241-9191
Mailing Address - Fax:703-532-2858
Practice Address - Street 1:311 PARK AVE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3300
Practice Address - Country:US
Practice Address - Phone:703-241-9191
Practice Address - Fax:703-532-2858
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2019-05-21
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2019-05-21
Provider Licenses
StateLicense IDTaxonomies
VA0401007660122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist