Provider Demographics
NPI:1093843179
Name:JASON A BERRY DDS PA
Entity Type:Organization
Organization Name:JASON A BERRY DDS PA
Other - Org Name:BERRY & BERRY DENTAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-326-4098
Mailing Address - Street 1:2600 JAMES ROAD
Mailing Address - Street 2:STE #100
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049
Mailing Address - Country:US
Mailing Address - Phone:817-326-4098
Mailing Address - Fax:817-326-4470
Practice Address - Street 1:2600 JAMES ROAD
Practice Address - Street 2:STE #100
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049
Practice Address - Country:US
Practice Address - Phone:817-326-4098
Practice Address - Fax:817-326-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197771223G0001X
TX193541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty