MEDICARE: MICHAEL P. BERRY, D.D.S., P.C.

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	:	1245450535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL P. BERRY, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	6004 N.W. 9 HWY.
Second Line	:
City	:	PARKVILLE
State	:	MO
Zip	:	64152-3549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6004 N.W. 9 HWY.
Second Line	:
City	:	PARKVILLE
State	:	MO
Zip	:	64152-3549
Country	:	US
Telephone Number	:	816-746-5437
Fax Number	:	816-746-8047

Authorized Official
Title or Position	:	PRESIDENT OF CORPORATION
Name	:	DR. MICHAEL P. BERRY
Credential	:	D.D.S.
Telephone Number	:	816-746-5437

Provider Enumeration Date	:	04/27/2007
Last Update Date	:	08/22/2020

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