Individual
KATHERINE E BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
12000 STONE LAKE RD, JICARILLA APACHE HEALTH CARE FACILITY, IHS, DULCE, NM 87528-0000
(575) 759-3291
(575) 759-3651
Mailing address
PO BOX 220, DULCE, NM 87528-0220
(575) 759-0062
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
532
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
08/30/2006
Last updated
06/03/2008
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