Active NPI
Robert H. Iezman, D.D.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Berkeley, CA
National Provider Identifier
1073593489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 31477
- Practice address
- 1525 Walnut St
Berkeley, CA 94709-1512 - Phone
- (510) 845-3511
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 31477 | CA | Primary |
Addresses
Primary practice location
1525 Walnut St
Berkeley, CA 94709-1512
Mailing address
1525 Walnut St
Berkeley, CA 94709-1512
Phone (510) 845-3511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31477 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073593489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1525 WALNUT ST",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947091512",
"telephone_number": "510-845-3511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 WALNUT ST",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947091512",
"telephone_number": "510-845-3511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IEZMAN",
"first_name": "ROBERT",
"middle_name": "H.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "31477",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.