MEDICARE: DR. JAMES W BERRY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11152	TX

General Provider Information

NPI Number	:	1053316141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES W BERRY D.D.S.

Provider Business Mailing Address
First Line	:	1605 N GARLAND AVE
Second Line	:	STE A
City	:	GARLAND
State	:	TX
Zip	:	75040-9418
Country	:	US
Telephone Number	:	972-272-9563
Fax Number	:	972-276-7279

Provider Business Practice Location Address
First Line	:	1605 N GARLAND AVE
Second Line	:	STE A
City	:	GARLAND
State	:	TX
Zip	:	75040-9418
Country	:	US
Telephone Number	:	972-272-9563
Fax Number	:	972-276-7279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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