Provider Demographics
NPI:1083108559
Name:JEFFREY G. CARBERRY, DMD, PC
Entity Type:Organization
Organization Name:JEFFREY G. CARBERRY, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-443-9000
Mailing Address - Street 1:203 E. PATRIOT ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501
Mailing Address - Country:US
Mailing Address - Phone:814-443-9000
Mailing Address - Fax:814-444-6127
Practice Address - Street 1:203 E. PATRIOT ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501
Practice Address - Country:US
Practice Address - Phone:814-443-9000
Practice Address - Fax:814-444-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty