Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 019-025884 | IL |
Y | 1223D0001X | Dental Public Health | 60532 | KS |
NPI | 1124013867 |
---|---|
Provider Name | Dr. Ellen Frances Berry |
First Address | Olathe, KS 66062-1857 |
Second Address | Olathe, KS 66062-1857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 29/03/2013 |