Individual provider Active NPI

Michael Evan Berman, DDS

  • General Practice Dentistry
  • Plymouth, MI
National Provider Identifier
1003166729
Registry record updated Mar 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901020803 Issued in MI
Practice address
9430 S Main St
Plymouth, MI 48170-4186
Phone
(734) 453-2200
Fax
(734) 453-2318
NPI assigned
Sep 11, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901020803 MI Primary

Addresses

Primary practice location

9430 S Main St
Plymouth, MI 48170-4186

Mailing address

9430 S Main St
Plymouth, MI 48170-4186
Phone (734) 453-2200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150805007145 MI Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 7113231036

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901020803MIMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Berman Family Dentistry PLLC General Practice Current Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1347321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490054400000",
    "number": "1003166729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9430 S MAIN ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704186",
            "telephone_number": "734-453-2200",
            "fax_number": "734-453-2318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9430 S MAIN ST",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704186",
            "telephone_number": "734-453-2200",
            "fax_number": "734-453-2318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERMAN",
        "first_name": "MICHAEL",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-11",
        "last_updated": "2017-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

Verify at the official NPI Registry.