Provider Demographics
NPI:1942690557
Name:MARK M BIERMA DDS MS, PLLC
Entity Type:Organization
Organization Name:MARK M BIERMA DDS MS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-275-6363
Mailing Address - Street 1:5000 S BROADBAND LN
Mailing Address - Street 2:STE 126
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5000 S BROADBAND LN
Practice Address - Street 2:STE 126
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2260
Practice Address - Country:US
Practice Address - Phone:605-275-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental