Provider Demographics
NPI:1811035066
Name:BERMAN, GARY M (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
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 1:9840 HAGGERTY RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-3443
Mailing Address - Country:US
Mailing Address - Phone:734-697-4400
Mailing Address - Fax:734-697-0519
Practice Address - Street 1:9840 HAGGERTY RD
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48111-3443
Practice Address - Country:US
Practice Address - Phone:734-697-4400
Practice Address - Fax:734-697-0519
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010127711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice