Provider Demographics
NPI:1003166729
Name:BERMAN, MICHAEL EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EVAN
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 1:9430 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-4186
Mailing Address - Country:US
Mailing Address - Phone:734-453-2200
Mailing Address - Fax:734-453-2318
Practice Address - Street 1:9430 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-4186
Practice Address - Country:US
Practice Address - Phone:734-453-2200
Practice Address - Fax:734-453-2318
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010208031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice