Provider Demographics
NPI:1841634169
Name:BERRY, DEVAN ROPPOSCH (DDS)
Entity type:Individual
Prefix:DR
First Name:DEVAN
Middle Name:ROPPOSCH
Last Name:BERRY
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 1:17 PAYNE ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-1111
Mailing Address - Country:US
Mailing Address - Phone:315-824-2250
Mailing Address - Fax:
Practice Address - Street 1:17 PAYNE ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1111
Practice Address - Country:US
Practice Address - Phone:315-824-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0573471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice