MEDICARE: DR. MICHAEL P BERRY D.D.S.

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	1223P0221X	Pediatric Dentistry	DE015875	MO

General Provider Information

NPI Number	:	1164412128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL P BERRY D.D.S.

Provider Business Mailing Address
First Line	:	6004 NW 9 HWY.
Second Line	:
City	:	PARKVILLE
State	:	MO
Zip	:	64152
Country	:	US
Telephone Number	:	816-746-5437
Fax Number	:	816-746-8047

Provider Business Practice Location Address
First Line	:	6004 NW 9 HWY.
Second Line	:
City	:	PARKVILLE
State	:	MO
Zip	:	64152
Country	:	US
Telephone Number	:	816-746-5437
Fax Number	:	816-746-8047

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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