Provider Demographics
NPI:1841690310
Name:BERRO FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:BERRO FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:HUSSEIN
Authorized Official - Last Name:BERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-522-3881
Mailing Address - Street 1:1756 N TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1271
Mailing Address - Country:US
Mailing Address - Phone:313-278-9600
Mailing Address - Fax:
Practice Address - Street 1:1756 N TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1271
Practice Address - Country:US
Practice Address - Phone:313-278-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010191291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty