Provider Demographics
NPI:1154614873
Name:BERRY, JOSHUA R (DDS)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:R
Last Name:BERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 E PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-2092
Mailing Address - Country:US
Mailing Address - Phone:765-286-4195
Mailing Address - Fax:765-286-4248
Practice Address - Street 1:1130 E PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-2092
Practice Address - Country:US
Practice Address - Phone:765-286-4195
Practice Address - Fax:765-286-4248
Is Sole Proprietor?:No
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011607A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist