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General NPI Number Information
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NPI Number | 1710992409
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Entity Type | Individual
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Provider Name | DJUANA MATTHEWS BERUK D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 217 HIGHWAY 82 E
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City | GREENVILLE
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State | MS
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Zip | 38701-5326
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Country | US
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Telephone | 662-332-0683
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Fax |
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Provider Business Mailing Address
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Address Line | 511 CEDAR ST
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City | GREENVILLE
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State | MS
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Zip | 38701-5302
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Country | US
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Telephone | 662-332-0683
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3479
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3322-04
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6746
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6892
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License Number State | TN
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