Provider Demographics
NPI:1356427389
Name:BERRY, RICHEE' K (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHEE'
Middle Name:K
Last Name:BERRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RICHEE'
Other - Middle Name:K
Other - Last Name:LEFTENANT-BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4449 MITCHELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3169
Mailing Address - Country:US
Mailing Address - Phone:301-383-0959
Mailing Address - Fax:240-334-2107
Practice Address - Street 1:4449 MITCHELLVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3169
Practice Address - Country:US
Practice Address - Phone:301-383-0959
Practice Address - Fax:240-334-2107
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD542180421OtherTAX ID