Healthcare Provider Details

I. General information

NPI: 1285799809
Provider Name (Legal Business Name): KAREN LEA BERRIGAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 NORTH 51ST AVE #B-230
GLENDALE AZ
85308-5097
US

IV. Provider business mailing address

20100 NORTH 51ST AVE #B-230
GLENDALE AZ
85308-5097
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-4386
  • Fax:
Mailing address:
  • Phone: 623-931-4386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3549
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: