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General NPI Number Information
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NPI Number | 1780654947
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Entity Type | Individual
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Provider Name | BERRY STAHL DMD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 370 BROAD AVE SUITE 200
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4305
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Country | US
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Telephone | 201-871-3555
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Fax |
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Provider Business Mailing Address
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Address Line | 380 BROAD AVE
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-4397
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Country | US
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Telephone | 201-816-8948
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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 | 14655
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 38634
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10236
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License Number State | FL
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