Healthcare Provider Details

I. General information

NPI: 1407110737
Provider Name (Legal Business Name): TAYLOR ERNEST BERRY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 25TH AVE NE SUITE 205
SEATTLE WA
98105-5667
US

IV. Provider business mailing address

4915 25TH AVE NE SUITE 205
SEATTLE WA
98105-5667
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-1600
  • Fax:
Mailing address:
  • Phone: 206-524-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDR60295295
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: