MEDICARE: DR. DOROTHEA 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	122300000X	Dentist	52968	CA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	52968	CA

General Provider Information

NPI Number	:	1851451108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHEA BERRY D.D.S.

Provider Business Mailing Address
First Line	:	2690 PACIFIC AVE STE 250
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2663
Country	:	US
Telephone Number	:	855-413-5009
Fax Number	:	562-317-5260

Provider Business Practice Location Address
First Line	:	2690 PACIFIC AVE STE 250
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2663
Country	:	US
Telephone Number	:	855-413-5009
Fax Number	:	562-317-5260

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

Provider Enumeration Date	:	12/09/2006
Last Update Date	:	02/08/2019

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