Healthcare Provider Details

I. General information

NPI: 1326427477
Provider Name (Legal Business Name): PAUL F BERMUDEZ MD, DDM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7633 E JEFFERSON AVE STE 70
DETROIT MI
48214-3730
US

IV. Provider business mailing address

7633 E JEFFERSON AVE STE 70
DETROIT MI
48214-3730
US

V. Phone/Fax

Practice location:
  • Phone: 313-499-4775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301504167
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.024928
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2901601179
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4301504167
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: