Provider Demographics
NPI:1023161981
Name:BERRY, THOMAS D (MD,DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:BERRY
Suffix:
Gender:M
Credentials:MD,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3280 HOWELL MILL RD NW
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4111
Mailing Address - Country:US
Mailing Address - Phone:404-351-5335
Mailing Address - Fax:404-351-1339
Practice Address - Street 1:3280 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 240
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4111
Practice Address - Country:US
Practice Address - Phone:404-351-5335
Practice Address - Fax:404-351-1339
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0321271223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery