Provider Demographics
NPI:1447334149
Name:BIRNHOLTZ, MARK DAVID (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:BIRNHOLTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39231 MIDDLEBELT
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 1:39231 MIDDLEBELT
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist