Healthcare Provider Details

I. General information

NPI: 1861530024
Provider Name (Legal Business Name): FOX & BERMAN, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9840 HAGGERTY RD
BELLEVILLE MI
48111-3443
US

IV. Provider business mailing address

9840 HAGGERTY RD
BELLEVILLE MI
48111-3443
US

V. Phone/Fax

Practice location:
  • Phone: 734-697-4400
  • Fax: 734-697-0519
Mailing address:
  • Phone: 734-697-4400
  • Fax: 734-697-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY MICHAEL BERMAN
Title or Position: VICE PRESIDENT
Credential: D.D.S.
Phone: 734-697-4400