Provider Demographics
NPI:1225295603
Name:BERRY, BRYAN WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:WILLIAM
Last Name:BERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E BROWARD BLVD STE 410
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2033
Mailing Address - Country:US
Mailing Address - Phone:954-463-4794
Mailing Address - Fax:954-763-9070
Practice Address - Street 1:800 E BROWARD BLVD STE 410
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2033
Practice Address - Country:US
Practice Address - Phone:954-463-4794
Practice Address - Fax:954-763-9070
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 9094122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist