Individual provider Active NPI

Allen B Berman, DDS

  • Dentist
  • Plymouth, MI
National Provider Identifier
1114975638
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
14052 Issued in MI
Practice address
9430 S Main St
Plymouth, MI 48170-4144
Phone
(734) 453-2200
Fax
(734) 453-2318
NPI assigned
May 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 14052 MI Primary
Counselor 101Y00000X 6401011696 MI

Addresses

Primary practice location

9430 S Main St
Plymouth, MI 48170-4144

Mailing address

9430 S Main St
Plymouth, MI 48170-4144
Phone (734) 453-2200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150729008844 MI Order and Referring Only - DentistPractitioner - Dentist 3072827476

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6401011696MIMDCounselor
14052MIMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455235200000",
    "number": "1114975638",
    "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": "481704144",
            "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": "481704144",
            "telephone_number": "734-453-2200",
            "fax_number": "734-453-2318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERMAN",
        "first_name": "ALLEN",
        "middle_name": "B",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2016-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "14052",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401011696",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

Verify at the official NPI Registry.