Provider Demographics
NPI:1033260237
Name:BERRY, RICHARD ANDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANDY
Last Name:BERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MAIN ST
Mailing Address - Street 2:PO BOX 149
Mailing Address - City:MEDWAY
Mailing Address - State:MA
Mailing Address - Zip Code:02053-1576
Mailing Address - Country:US
Mailing Address - Phone:508-533-7461
Mailing Address - Fax:508-533-7455
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:MA
Practice Address - Zip Code:02053-1576
Practice Address - Country:US
Practice Address - Phone:508-533-7461
Practice Address - Fax:508-533-7455
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist