Provider Demographics
NPI:1194984948
Name:BERRY, DANA ERIC (DDS)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:ERIC
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 1:1140 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:CA
Mailing Address - Zip Code:95334-1257
Mailing Address - Country:US
Mailing Address - Phone:209-394-9713
Mailing Address - Fax:209-394-9093
Practice Address - Street 1:7970 LANDER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HILMAR
Practice Address - State:CA
Practice Address - Zip Code:95324-8350
Practice Address - Country:US
Practice Address - Phone:209-262-1817
Practice Address - Fax:209-262-1816
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice