Healthcare Provider Details

I. General information

NPI: 1699889352
Provider Name (Legal Business Name): STEPHEN ERIC BERRY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3123 W 23RD ST
PANAMA CITY FL
32405-1828
US

IV. Provider business mailing address

3123 W 23RD ST
PANAMA CITY FL
32405-1828
US

V. Phone/Fax

Practice location:
  • Phone: 850-481-1969
  • Fax: 850-481-1972
Mailing address:
  • Phone: 850-481-1969
  • Fax: 850-481-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 16280
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN16280
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: