Provider Demographics
NPI:1346016250
Name:BERRY DENTAL
Entity Type:Organization
Organization Name:BERRY DENTAL
Other - Org Name:VIVA DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-910-6975
Mailing Address - Street 1:9544 ROYAL ESTATES BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-8896
Mailing Address - Country:US
Mailing Address - Phone:305-910-6975
Mailing Address - Fax:
Practice Address - Street 1:2522 JACKS ROAD, UNIT #2A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897
Practice Address - Country:US
Practice Address - Phone:305-910-6975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center