Provider Demographics
NPI:1437711694
Name:OTCHERE, BERYL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BERYL
Middle Name:
Last Name:OTCHERE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BERYL
Other - Middle Name:
Other - Last Name:QUAYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12117 TOWER FRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6716
Mailing Address - Country:US
Mailing Address - Phone:817-404-9547
Mailing Address - Fax:
Practice Address - Street 1:6510 BABCOCK RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2302
Practice Address - Country:US
Practice Address - Phone:210-558-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX375731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice