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General NPI Number Information
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NPI Number | 1912048828
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Entity Type | Organization
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Legal Business Name | VERNON E. O'BERRY JR. DDS PC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 GRESHAM DR SUITE 708
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City | NORFOLK
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State | VA
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Zip | 23507-1901
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Country | US
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Telephone | 757-627-1882
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Fax | 757-627-7807
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Provider Business Mailing Address
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Address Line | 400 GRESHAM DR. SUITE 708
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City | NORFOLK
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State | VA
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Zip | 23507-1234
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Country | US
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Telephone | 757-627-1882
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Fax | 757-627-7807
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Authorized Official
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Title or Position | OWNER
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Name | DR. VERNON E. O'BERRY JR.
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Credential | DDS
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Telephone | 757-627-1882
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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 | 6196
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License Number State | VA
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