Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN#9546 | FL |
NPI | 1033396353 |
---|---|
Provider Name | Dr. Lillian Ruth Berry |
First Address | Largo, FL 33770-6103 |
Second Address | Largo, FL 33770-6103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2008 |
Last Update Date | 29/01/2008 |