Provider Demographics
NPI:1851451108
Name:BERRY, DOROTHEA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOROTHEA
Middle Name:
Last Name:BERRY
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 1:2690 PACIFIC AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2663
Mailing Address - Country:US
Mailing Address - Phone:855-413-5009
Mailing Address - Fax:562-317-5260
Practice Address - Street 1:2690 PACIFIC AVE STE 250
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2663
Practice Address - Country:US
Practice Address - Phone:855-413-5009
Practice Address - Fax:562-317-5260
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52968122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist