MEDICARE: DR. STEPHEN ERIC BERRY D.M.D.

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	DN 16280	FL
2	1223P0221X	Pediatric Dentistry	DN16280	FL

General Provider Information

NPI Number	:	1699889352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN ERIC BERRY D.M.D.

Provider Business Mailing Address
First Line	:	3123 W 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-1828
Country	:	US
Telephone Number	:	850-481-1969
Fax Number	:	850-481-1972

Provider Business Practice Location Address
First Line	:	3123 W 23RD ST
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-1828
Country	:	US
Telephone Number	:	850-481-1969
Fax Number	:	850-481-1972

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	12/18/2025

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