Provider Demographics
NPI:1629097027
Name:BERRY, JOHN E SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:BERRY
Suffix:SR
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 1:21876 ADDINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3970
Mailing Address - Country:US
Mailing Address - Phone:440-835-5388
Mailing Address - Fax:440-835-2101
Practice Address - Street 1:24803 DETROIT RD
Practice Address - Street 2:SUITE A
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2553
Practice Address - Country:US
Practice Address - Phone:440-835-5388
Practice Address - Fax:440-835-2101
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice