Provider Demographics
NPI:1710992409
Name:BERUK, DJUANA MATTHEWS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DJUANA
Middle Name:MATTHEWS
Last Name:BERUK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-5302
Mailing Address - Country:US
Mailing Address - Phone:662-332-0683
Mailing Address - Fax:
Practice Address - Street 1:217 HIGHWAY 82 E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-5326
Practice Address - Country:US
Practice Address - Phone:662-332-0683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34791223G0001X
MS3322-041223G0001X
KY67461223G0001X
TN68921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice