MEDICARE: BERRY BRACES, PLLC

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	0022958	TX

General Provider Information

NPI Number	:	1417141813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BERRY BRACES, PLLC

Provider Business Mailing Address
First Line	:	944 E BERRY ST STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-4450
Country	:	US
Telephone Number	:	817-924-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	944 E BERRY ST STE B
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-4450
Country	:	US
Telephone Number	:	817-924-2722
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. STEFANIE L CAPARAS
Credential	:
Telephone Number	:	817-924-2722

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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