Provider Demographics
NPI:1740424225
Name:DEANNA S. BERRY, D.D.S.
Entity Type:Organization
Organization Name:DEANNA S. BERRY, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:I
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-631-1352
Mailing Address - Street 1:901 SW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3801
Mailing Address - Country:US
Mailing Address - Phone:405-631-1352
Mailing Address - Fax:405-631-1417
Practice Address - Street 1:901 SW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3801
Practice Address - Country:US
Practice Address - Phone:405-631-1352
Practice Address - Fax:405-631-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty