Provider Demographics
NPI:1881600070
Name:BERRE, JR., EDGAR L (DDS)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:L
Last Name:BERRE, 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 1:7655 5 MILE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4326
Mailing Address - Country:US
Mailing Address - Phone:513-232-6050
Mailing Address - Fax:513-232-5800
Practice Address - Street 1:7655 5 MILE RD
Practice Address - Street 2:SUITE 220
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4326
Practice Address - Country:US
Practice Address - Phone:513-232-6050
Practice Address - Fax:513-232-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics