Provider Demographics
NPI:1467004093
Name:BERRY, HUSSEIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:HUSSEIN
Middle Name:
Last Name:BERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25850 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-4924
Mailing Address - Country:US
Mailing Address - Phone:734-992-8688
Mailing Address - Fax:
Practice Address - Street 1:25850 EUREKA RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-4924
Practice Address - Country:US
Practice Address - Phone:734-992-8688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-13
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901600186OtherDELTA DENTAL
MI2901600186Medicaid