Provider Demographics
NPI:1457684979
Name:BERRY, MARI N (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:N
Last Name:BERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 PALMER CT
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-9876
Mailing Address - Country:US
Mailing Address - Phone:802-649-7293
Mailing Address - Fax:
Practice Address - Street 1:144 PALMER CT
Practice Address - Street 2:SUITE 1A
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-9876
Practice Address - Country:US
Practice Address - Phone:802-649-7293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.00534421223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice