MEDICARE: MARK M BIERMA DDS MS, PLLC

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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1942690557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK M BIERMA DDS MS, PLLC

Provider Business Mailing Address
First Line	:	5000 S BROADBAND LN
Second Line	:	STE 126
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2260
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 S BROADBAND LN
Second Line	:	STE 126
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2260
Country	:	US
Telephone Number	:	605-275-6363
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARK BIERMA
Credential	:
Telephone Number	:	605-275-6363

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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