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General NPI Number Information
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NPI Number | 1972855773
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Entity Type | Organization
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Legal Business Name | ERIC BERRY DMD PA
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3123 W 23RD ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-1828
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Country | US
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Telephone | 850-481-1969
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Fax | 850-481-1972
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Provider Business Mailing Address
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Address Line | 3123 W 23RD ST
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City | PANAMA CITY
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State | FL
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Zip | 32405-1828
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Country | US
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Telephone | 850-481-1969
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Fax | 850-481-1972
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHEN ERIC BERRY
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Credential | D.M.D.
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Telephone | 850-481-1969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN16280
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License Number State | FL
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