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NPI Code Detail

MEDICARE: DR. MARVIN WADE BERLIN DDS

MEDICARE: DR. MARVIN WADE BERLIN DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist16034TX

General Provider Information

NPI Number : 1114143575
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARVIN WADE BERLIN DDS
Provider Business Mailing Address
First Line : 1716 W VIRGINIA ST
Second Line :
City : MCKINNEY
State : TX
Zip : 75069-7864
Country : US
Telephone Number : 972-542-0146
Fax Number :
Provider Business Practice Location Address
First Line : 1716 W VIRGINIA ST
Second Line :
City : MCKINNEY
State : TX
Zip : 75069-7864
Country : US
Telephone Number : 972-542-0146
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2007
Last Update Date : 07/08/2007

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