Provider Demographics
NPI:1083126320
Name:VERNON E. O'BERRY, JR. DDS
Entity Type:Organization
Organization Name:VERNON E. O'BERRY, JR. DDS
Other - Org Name:VERNON E. O'BERRY, JR. DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:E
Authorized Official - Last Name:O'BERRY, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-627-1882
Mailing Address - Street 1:400 GRESHAM DR STE 708
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1991
Mailing Address - Country:US
Mailing Address - Phone:757-627-1882
Mailing Address - Fax:757-627-7807
Practice Address - Street 1:400 GRESHAM DR STE 708
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1991
Practice Address - Country:US
Practice Address - Phone:757-627-1882
Practice Address - Fax:757-627-7807
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty