Provider Demographics
NPI:1912237959
Name:BERRY, THOMAS P (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
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 1:13625 CALIFORNIA ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5304
Mailing Address - Country:US
Mailing Address - Phone:402-933-8005
Mailing Address - Fax:402-504-1338
Practice Address - Street 1:13625 CALIFORNIA ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5304
Practice Address - Country:US
Practice Address - Phone:402-933-8005
Practice Address - Fax:402-504-1338
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025440200Medicaid