MEDICARE: MR. DANIEL HOWARD BERRY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	06193	CO

General Provider Information

NPI Number	:	1033193834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL HOWARD BERRY DDS

Provider Business Mailing Address
First Line	:	403 E 1ST ST
Second Line	:
City	:	TRINIDAD
State	:	CO
Zip	:	81082-3010
Country	:	US
Telephone Number	:	719-846-2259
Fax Number	:	719-845-8117

Provider Business Practice Location Address
First Line	:	403 E 1ST ST
Second Line	:
City	:	TRINIDAD
State	:	CO
Zip	:	81082-3010
Country	:	US
Telephone Number	:	719-846-2259
Fax Number	:	719-845-8117

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/08/2007

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