Provider Demographics
NPI:1255729273
Name:MARI N BERRY DMD PLC
Entity type:Organization
Organization Name:MARI N BERRY DMD PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARI
Authorized Official - Middle Name:N
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-410-9879
Mailing Address - Street 1:187 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-8023
Mailing Address - Country:US
Mailing Address - Phone:802-295-5252
Mailing Address - Fax:802-281-6272
Practice Address - Street 1:187 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-8023
Practice Address - Country:US
Practice Address - Phone:802-295-5252
Practice Address - Fax:802-281-6272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0053442261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental