Provider Demographics
NPI:1508967829
Name:BERRIS, DAVID JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOEL
Last Name:BERRIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 364
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-0364
Mailing Address - Country:US
Mailing Address - Phone:313-295-2600
Mailing Address - Fax:313-295-7927
Practice Address - Street 1:9310 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3362
Practice Address - Country:US
Practice Address - Phone:313-295-2600
Practice Address - Fax:313-295-7927
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010095231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice