Provider Demographics
NPI:1104891985
Name:BERMAN, MARK D (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:BERMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:44200 GARFIELD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1145
Mailing Address - Country:US
Mailing Address - Phone:586-263-0770
Mailing Address - Fax:586-263-9811
Practice Address - Street 1:44200 GARFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1145
Practice Address - Country:US
Practice Address - Phone:586-263-0770
Practice Address - Fax:586-263-9811
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI124531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice