Provider Demographics
NPI:1619546009
Name:BERRY, GARRETT WARNER (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:WARNER
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 1:7120 CABIN FEVER ST UNIT 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3142
Mailing Address - Country:US
Mailing Address - Phone:702-528-1333
Mailing Address - Fax:
Practice Address - Street 1:9777 BERMUDA RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-3571
Practice Address - Country:US
Practice Address - Phone:702-699-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV74831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice