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General NPI Number Information
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NPI Number | 1124013867
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Entity Type | Individual
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Provider Name | ELLEN FRANCES BERRY DDS
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Gender | Female
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 03/29/2013
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Provider Practice Location Address
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Address Line | 407 S CLAIRBORNE RD SUITE 104
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City | OLATHE
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State | KS
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Zip | 66062-1857
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Country | US
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Telephone | 855-886-6938
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Fax | 913-393-9934
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Provider Business Mailing Address
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Address Line | 407 S CLAIRBORNE RD SUITE 104
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City | OLATHE
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State | KS
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Zip | 66062-1857
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Country | US
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Telephone | 855-886-6938
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Fax | 913-393-9934
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-025884
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 60532
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License Number State | KS
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