Provider Demographics
NPI:1073892246
Name:BERRY, CRAIG (DMD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 RIVER RD STE K3
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-8924
Mailing Address - Country:US
Mailing Address - Phone:973-335-8046
Mailing Address - Fax:
Practice Address - Street 1:150 RIVER RD STE K3
Practice Address - Street 2:
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-8924
Practice Address - Country:US
Practice Address - Phone:973-335-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055580-1122300000X
NY0555801223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist