MEDICARE: PANHANDLE PEDIATRIC DENTISTRY, PLLC

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	1223P0221X	Pediatric Dentistry	DN16280	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1699889352	OTHER		NPI TYPE 1 FOR STEPHEN E BERRY

General Provider Information

NPI Number	:	1972855773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANHANDLE PEDIATRIC DENTISTRY, PLLC

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	:	OWNER
Name	:	DR. STEPHEN ERIC BERRY
Credential	:	D.M.D.
Telephone Number	:	850-481-1969

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	12/29/2025

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