Provider Demographics
NPI:1114975638
Name:BERMAN, ALLEN B (DDS)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:B
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:48170-4144
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:48170-4144
Practice Address - Country:US
Practice Address - Phone:734-453-2200
Practice Address - Fax:734-453-2318
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14052122300000X
MI6401011696101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor