Provider Demographics
NPI:1902965312
Name:MARK D BIRNHOTZ DDS PC
Entity Type:Organization
Organization Name:MARK D BIRNHOTZ DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:BIRNHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-626-9915
Mailing Address - Street 1:32931 MIDDLEBELT RD
Mailing Address - Street 2:SUITE 612
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334
Mailing Address - Country:US
Mailing Address - Phone:248-626-9915
Mailing Address - Fax:248-851-0843
Practice Address - Street 1:32931 MIDDLEBELT RD
Practice Address - Street 2:SUITE 612
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334
Practice Address - Country:US
Practice Address - Phone:248-626-9915
Practice Address - Fax:248-851-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty