Healthcare Provider Details

I. General information

NPI: 1215049705
Provider Name (Legal Business Name): JAMES F DEBERRY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 RICHMOND RD
WARRENSVILLE HTS OH
44128
US

IV. Provider business mailing address

23751 S WOODLAND RD
SHAKER HTS OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 216-593-7600
  • Fax: 216-593-7601
Mailing address:
  • Phone: 216-283-0015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30014353
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: