Healthcare Provider Details

I. General information

NPI: 1396908489
Provider Name (Legal Business Name): H BERATIS DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 EXCHANGE STREET THE EDISON
LYNN MA
01901-1417
US

IV. Provider business mailing address

85 EXCHANGE ST
LYNN MA
01901-1417
US

V. Phone/Fax

Practice location:
  • Phone: 781-592-0222
  • Fax:
Mailing address:
  • Phone: 781-592-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. HARRY BERATIS
Title or Position: OWNER
Credential: DDS
Phone: 781-592-0222