Provider Demographics
NPI:1548584998
Name:ACCESS DENTAL OF BERRY, P.A.
Entity Type:Organization
Organization Name:ACCESS DENTAL OF BERRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:MAI
Authorized Official - Last Name:TRIEU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:682-365-9115
Mailing Address - Street 1:4201 E. BERRY STREET
Mailing Address - Street 2:SUITE #15
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4201 E. BERRY STREET
Practice Address - Street 2:SUITE #15
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76105
Practice Address - Country:US
Practice Address - Phone:682-365-9115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-15
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty