Provider Demographics
NPI:1275650137
Name:CARBERRY, JEFFREY G (DMD, PC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:CARBERRY
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E PATRIOT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2013
Mailing Address - Country:US
Mailing Address - Phone:814-443-9000
Mailing Address - Fax:814-443-9000
Practice Address - Street 1:203 E PATRIOT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501
Practice Address - Country:US
Practice Address - Phone:814-443-9000
Practice Address - Fax:814-443-9000
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021951-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice