Healthcare Provider Details

I. General information

NPI: 1114975638
Provider Name (Legal Business Name): ALLEN B BERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 S MAIN ST
PLYMOUTH MI
48170-4144
US

IV. Provider business mailing address

9430 S MAIN ST
PLYMOUTH MI
48170-4144
US

V. Phone/Fax

Practice location:
  • Phone: 734-453-2200
  • Fax: 734-453-2318
Mailing address:
  • Phone: 734-453-2200
  • Fax: 734-453-2318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14052
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401011696
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: