Provider Demographics
NPI:1013918135
Name:BERSCHLER, BENJAMIN MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MARK
Last Name:BERSCHLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W. MONROE STREET
Mailing Address - Street 2:#131 DOWNTOWN PHOENIX DENTAL
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003
Mailing Address - Country:US
Mailing Address - Phone:602-626-7952
Mailing Address - Fax:
Practice Address - Street 1:111 W. MONROE STREET
Practice Address - Street 2:#131 DOWNTOWN PHOENIX DENTAL
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003
Practice Address - Country:US
Practice Address - Phone:602-626-7952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7500122300000X
AZD7500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist