# MARK D. BERARD, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942378419
- **Authorized official:** DR. MARK DANIEL BERARD D.D.S. (DENTIST/OWNER)
- **Authorized official phone:** (616) 392-2853

## Contact information

- **Practice address:** 203 WEST 30TH STREET, HOLLAND, MI 49423
- **Practice address phone:** (616) 392-2853
- **Practice address fax:** (616) 392-2568
- **Mailing address:** 203 WEST 30TH STREET, HOLLAND, MI 49423
- **Mailing address phone:** (616) 392-2853
- **Mailing address fax:** (616) 392-2568

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 02097814533 | MI | — |
| 1223G0001X | General Practice Dentistry | 2901019128 | MI | Yes |

## Other

- **Enumeration date:** 12/01/2006
- **Last updated:** 02/03/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1884295 | UNITED CONCORDIA | — |
| 01 | — | 625904 | UNITED CONCORDIA | — |
| 01 | — | D145330 | BCBSM | MI |
| 01 | — | D801446 | BCBSM | — |