Provider Demographics
NPI:1821000795
Name:L. RUTH BERRY, DMD, PA
Entity Type:Organization
Organization Name:L. RUTH BERRY, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:727-584-4235
Mailing Address - Street 1:168 14TH ST SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-6103
Mailing Address - Country:US
Mailing Address - Phone:727-584-4235
Mailing Address - Fax:727-584-3859
Practice Address - Street 1:168 14TH ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-6103
Practice Address - Country:US
Practice Address - Phone:727-584-4235
Practice Address - Fax:727-584-3859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN#95461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty