Provider Demographics
NPI:1659545580
Name:MARK D. BERMAN, D.D.S.
Entity Type:Organization
Organization Name:MARK D. BERMAN, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-263-0770
Mailing Address - Street 1:44200 GARFIELD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1142
Mailing Address - Country:US
Mailing Address - Phone:586-263-0770
Mailing Address - Fax:586-263-9811
Practice Address - Street 1:44200 GARFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1142
Practice Address - Country:US
Practice Address - Phone:586-263-0770
Practice Address - Fax:586-263-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI124531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty