Provider Demographics
NPI:1104893999
Name:BERRY, SCOTT T (DMD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:BERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:SCOTT
Other - Middle Name:T
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:592 PALM AVE.
Mailing Address - Street 2:APT A
Mailing Address - City:CARPINTERIA
Mailing Address - State:CA
Mailing Address - Zip Code:93013
Mailing Address - Country:US
Mailing Address - Phone:805-660-3595
Mailing Address - Fax:
Practice Address - Street 1:NAVAL SUPPORT ACTIVITY MONTEREY
Practice Address - Street 2:1 UNIVERSITY CIRCLE
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93943
Practice Address - Country:US
Practice Address - Phone:831-656-2477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA32927122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist