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General NPI Number Information
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NPI Number | 1558683086
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Entity Type | Organization
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Legal Business Name | BERRY CHILDREN DENTAL
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Dates
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Enumeration Date | 02/25/2010
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 10208 LAKE ARBOR WAY
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-3113
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Country | US
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Telephone | 301-333-2282
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Fax | 301-333-2286
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Provider Business Mailing Address
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Address Line | 10208 LAKE ARBOR WAY
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City | MITCHELLVILLE
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State | MD
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Zip | 20721-3113
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Country | US
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Telephone | 301-333-2282
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Fax | 301-333-2286
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RICHEE BERRY
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Credential | DDS
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Telephone | 301-333-2282
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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