Provider Demographics
NPI:1134200231
Name:O'BERRY, JR., VERNON E (DDS)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:E
Last Name:O'BERRY, JR.
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 BISHOPSGATE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6182
Mailing Address - Country:US
Mailing Address - Phone:757-627-1882
Mailing Address - Fax:757-627-7807
Practice Address - Street 1:708 MEDICAL TOWER
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-627-1882
Practice Address - Fax:757-627-7807
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010061961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice