Provider Demographics
NPI:1306041496
Name:BERRY, ADAM W (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:W
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 1:1025 153RD ST SE STE 102
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4051
Mailing Address - Country:US
Mailing Address - Phone:425-368-0608
Mailing Address - Fax:425-368-0694
Practice Address - Street 1:1025 153RD ST SE STE 102
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-4051
Practice Address - Country:US
Practice Address - Phone:425-368-0608
Practice Address - Fax:425-368-0694
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010312122300000X
WADE 103121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist