Provider Demographics
NPI:1972855773
Name:ERIC BERRY DMD PA
Entity Type:Organization
Organization Name:ERIC BERRY DMD PA
Other - Org Name:PANHANDLE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-481-1969
Mailing Address - Street 1:3123 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-1828
Mailing Address - Country:US
Mailing Address - Phone:850-481-1969
Mailing Address - Fax:850-481-1972
Practice Address - Street 1:3123 W 23RD ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-1828
Practice Address - Country:US
Practice Address - Phone:850-481-1969
Practice Address - Fax:850-481-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN162801223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699889352OtherNPI TYPE 1 FOR STEPHEN E BERRY
1699889352OtherNPI TYPE 1 FOR STEPHEN E BERRY