Provider Demographics
NPI:1215042460
Name:HELLERMAN, MARK BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRUCE
Last Name:HELLERMAN
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 1:4801 SOUTH UNIVERSITY DRIVE
Mailing Address - Street 2:#112
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-434-0600
Mailing Address - Fax:954-434-0143
Practice Address - Street 1:4801 SOUTH UNIVERSITY DRIVE
Practice Address - Street 2:#112
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-434-0600
Practice Address - Fax:954-434-0143
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice