Provider Demographics
NPI:1124013867
Name:BERRY, ELLEN FRANCES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:FRANCES
Last Name:BERRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELLEN
Other - Middle Name:FRANCES
Other - Last Name:OKONIEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:407 S CLAIRBORNE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1857
Mailing Address - Country:US
Mailing Address - Phone:855-886-6938
Mailing Address - Fax:913-393-9934
Practice Address - Street 1:407 S CLAIRBORNE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1857
Practice Address - Country:US
Practice Address - Phone:855-886-6938
Practice Address - Fax:913-393-9934
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025884122300000X
KS605321223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist