Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Dental |
261QD0000X | |||
Clinic/Center |
261Q00000X |
| NPI Number | 1346016250 |
| LBN Legal business name | BERRY DENTAL |
| Authorized official | JULIANA CORREAL - (GENERAL DENTIST) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 12/01/2023 |
| Last updated | 04/01/2024 - About 2 years ago |
| Identifiers | n/a |
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