Provider Demographics
NPI:1154591808
Name:BERRY FAMILY DENTISTRY WYLIE
Entity type:Organization
Organization Name:BERRY FAMILY DENTISTRY WYLIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-442-0078
Mailing Address - Street 1:901 W. FM 544
Mailing Address - Street 2:STE. 100
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098
Mailing Address - Country:US
Mailing Address - Phone:972-442-0078
Mailing Address - Fax:
Practice Address - Street 1:901 W. FM 544
Practice Address - Street 2:STE. 100
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098
Practice Address - Country:US
Practice Address - Phone:972-442-0078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty