Healthcare Provider Details

I. General information

NPI: 1033193834
Provider Name (Legal Business Name): DANIEL HOWARD BERRY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 1ST ST
TRINIDAD CO
81082-3010
US

IV. Provider business mailing address

403 E 1ST ST
TRINIDAD CO
81082-3010
US

V. Phone/Fax

Practice location:
  • Phone: 719-846-2259
  • Fax: 719-845-8117
Mailing address:
  • Phone: 719-846-2259
  • Fax: 719-845-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number06193
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: