Provider Demographics
NPI:1366551434
Name:DREIMAN, BERNARD B (DDS)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:B
Last Name:DREIMAN
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 1:1612 N BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-1872
Mailing Address - Country:US
Mailing Address - Phone:765-662-2068
Mailing Address - Fax:765-662-3210
Practice Address - Street 1:1612 N BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-1872
Practice Address - Country:US
Practice Address - Phone:765-662-2068
Practice Address - Fax:765-662-3210
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1223S0112X1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084054OtherBLUE CROSS BLUE SHIELD
INU12015Medicare UPIN
IN292890Medicare ID - Type Unspecified