Provider Demographics
NPI:1568629723
Name:BERRY, JASON ALBERT (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALBERT
Last Name:BERRY
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 JAMES RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-2927
Mailing Address - Country:US
Mailing Address - Phone:817-326-4098
Mailing Address - Fax:817-326-4470
Practice Address - Street 1:2600 JAMES RD
Practice Address - Street 2:STE. 100
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-2927
Practice Address - Country:US
Practice Address - Phone:817-326-4098
Practice Address - Fax:817-326-4470
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX197771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice