Provider Demographics
NPI:1699878249
Name:HI BERRY INC
Entity type:Organization
Organization Name:HI BERRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:BERRY-HOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-732-8584
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:305 MEADOWLAND DR
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278
Mailing Address - Country:US
Mailing Address - Phone:919-732-8584
Mailing Address - Fax:919-732-8545
Practice Address - Street 1:305 MEADOWLAND DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278
Practice Address - Country:US
Practice Address - Phone:919-732-8584
Practice Address - Fax:919-732-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990678Medicaid
NC8990678Medicaid