Provider Demographics
NPI:1275067845
Name:BERRYMAN FAMILY DENTISTRY, INC.
Entity Type:Organization
Organization Name:BERRYMAN FAMILY DENTISTRY, INC.
Other - Org Name:BERRYMAN FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-283-4981
Mailing Address - Street 1:228 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:OELWEIN
Mailing Address - State:IA
Mailing Address - Zip Code:50662-2403
Mailing Address - Country:US
Mailing Address - Phone:319-283-4981
Mailing Address - Fax:319-283-6630
Practice Address - Street 1:228 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:OELWEIN
Practice Address - State:IA
Practice Address - Zip Code:50662-2403
Practice Address - Country:US
Practice Address - Phone:319-283-4981
Practice Address - Fax:319-283-6630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty