MEDICARE: BRYAN WILLIAM 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	122300000X	Dentist	DN 9094	FL

General Provider Information

NPI Number	:	1225295603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN WILLIAM BERRY D.D.S.

Provider Business Mailing Address
First Line	:	800 E BROWARD BLVD STE 410
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2033
Country	:	US
Telephone Number	:	954-463-4794
Fax Number	:	954-763-9070

Provider Business Practice Location Address
First Line	:	800 E BROWARD BLVD STE 410
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-2033
Country	:	US
Telephone Number	:	954-463-4794
Fax Number	:	954-763-9070

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/21/2008

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