Provider Demographics
NPI:1528040474
Name:DR GEORGE E BERRYMAN DDS
Entity Type:Organization
Organization Name:DR GEORGE E BERRYMAN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:P
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-558-9008
Mailing Address - Street 1:838 OLD GEORGE WASHINGTON HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323
Mailing Address - Country:US
Mailing Address - Phone:757-558-9008
Mailing Address - Fax:757-558-9042
Practice Address - Street 1:838 OLD GEORGE WASHINGTON HWY
Practice Address - Street 2:SUITE C
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23323
Practice Address - Country:US
Practice Address - Phone:757-558-9008
Practice Address - Fax:757-558-9042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007804768Medicaid