Provider Demographics
NPI:1063527612
Name:MARK B HELLERMAN DDS PA
Entity type:Organization
Organization Name:MARK B HELLERMAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HELLERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-434-0600
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty