Provider Demographics
NPI:1730225111
Name:BERY, PAUL F (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:BERY
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 1:100 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4868
Mailing Address - Country:US
Mailing Address - Phone:847-236-1230
Mailing Address - Fax:847-475-7883
Practice Address - Street 1:636 CHURCH ST
Practice Address - Street 2:STE#517
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:US
Practice Address - Phone:847-475-0120
Practice Address - Fax:847-475-7883
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics