Provider Demographics
NPI:1083606180
Name:BIERSCHBACH, MARK (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BIERSCHBACH
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:PO BOX 592
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-0592
Mailing Address - Country:US
Mailing Address - Phone:605-432-5032
Mailing Address - Fax:605-432-4844
Practice Address - Street 1:1203 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1543
Practice Address - Country:US
Practice Address - Phone:605-432-5032
Practice Address - Fax:605-432-4844
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4999199OtherBCBS OF SD
MN4300482OtherDELTA DENTAL OF MN
SD7801810Medicaid
CA837660OtherUNITED CONCORDIA
TN4032700OtherBCBS OF TN
MN66814BIOtherBCBS OF MN
ND989074OtherBCBS OF ND