| Organization Name: | MICHAEL W BERRY DDS PC |
| NPI Number: | 1063596088 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL WAYNE BERRY (DENTIST OWNER) |
| Mailing Address: | 110 E Rollins St Moberly |
| State: | MO US |
| Postal Code: | 652702269 |
| Phone Number: | 6602631133 |
| Fax Number: | 6602639181 |
| NPI Enumeration Date: | 10/25/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 014845 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |