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General NPI Number Information
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NPI Number | 1255015418
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Entity Type | Individual
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Provider Name | MACIE DENISE BERRY DMD
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Gender | Female
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Dates
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Enumeration Date | 06/09/2023
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Last Update Date | 06/09/2023
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Provider Practice Location Address
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Address Line | 8800 BERNWOOD PKWY STE 4
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-9527
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Country | US
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Telephone | 239-949-1805
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Fax |
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Provider Business Mailing Address
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Address Line | 16282 ALLURA CIR
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City | NAPLES
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State | FL
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Zip | 34110-9274
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Country | US
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Telephone | 305-878-9227
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Fax |
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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 | DN28030
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License Number State | FL
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