Organization Name: | MARI N BERRY DMD PLC |
NPI Number: | 1255729273 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARI N. BERRY (OWNER/MEMBER) |
Mailing Address: | 187 Highland Ave White River Junction |
State: | VT US |
Postal Code: | 050018023 |
Phone Number: | 8022955252 |
Fax Number: | 8022816272 |
NPI Enumeration Date: | 12/29/2014 |
NPI Last Update Date: | 01/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 016.0053442 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |