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General NPI Number Information
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NPI Number | 1346016250
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Entity Type | Organization
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Legal Business Name | BERRY DENTAL
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 2522 JACKS ROAD, UNIT #2A
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City | DAVENPORT
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State | FL
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Zip | 33897
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Country | US
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Telephone | 305-910-6975
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Fax |
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Provider Business Mailing Address
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Address Line | 9544 ROYAL ESTATES BLVD
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City | ORLANDO
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State | FL
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Zip | 32836-8896
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Country | US
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Telephone | 305-910-6975
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JULIANA CORREAL
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Credential | DMD
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Telephone | 305-910-6975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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