Provider Demographics
NPI:1669513990
Name:BERRO, SAMUEL S (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S
Last Name:BERRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3662 KATELLA AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3124
Mailing Address - Country:US
Mailing Address - Phone:562-598-3333
Mailing Address - Fax:562-598-3337
Practice Address - Street 1:3662 KATELLA AVE
Practice Address - Street 2:STE 200
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3124
Practice Address - Country:US
Practice Address - Phone:562-598-3333
Practice Address - Fax:562-598-3337
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD289051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics