Provider Demographics
NPI:1699964791
Name:BEREY, SUSAN E (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:BEREY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WINTERSET LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1646
Mailing Address - Country:US
Mailing Address - Phone:917-767-0608
Mailing Address - Fax:
Practice Address - Street 1:60 CHURCH ST STE 15
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2394
Practice Address - Country:US
Practice Address - Phone:917-767-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0514631223X0400X
CT92061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics