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General NPI Number Information
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NPI Number | 1285832188
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Entity Type | Individual
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Provider Name | GERALD BARRY BERENSON DDS
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Gender | Male
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 20 JULIO DR
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City | SHREWSBURY
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State | MA
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Zip | 01545-3056
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Country | US
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Telephone | 508-842-6881
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Fax |
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Provider Business Mailing Address
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Address Line | 12 AUSTIN DR
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City | SUDBURY
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State | MA
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Zip | 01776-1739
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Country | US
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Telephone | 978-443-5247
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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 | 11899
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License Number State | MA
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