Healthcare Provider Details

I. General information

NPI: 1336268838
Provider Name (Legal Business Name): MAIER BERKOWITZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25882 ORCHARD LAKE RD SUITE 105
FARMINGTON HILLS MI
48336-1292
US

IV. Provider business mailing address

1600 HAGYS FORD RD APT. 7K
NARBERTH PA
19072-1051
US

V. Phone/Fax

Practice location:
  • Phone: 248-442-6600
  • Fax: 888-330-4331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS015033L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: