Provider Demographics
NPI:1962143578
Name:BERENSHTEYN, MARK L (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:BERENSHTEYN
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 1:164 ELM ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-3192
Mailing Address - Country:US
Mailing Address - Phone:917-250-7771
Mailing Address - Fax:
Practice Address - Street 1:164 ELM ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-3192
Practice Address - Country:US
Practice Address - Phone:978-345-5563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH048491223G0001X
MADN100000771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice