Individual
MR. JOHN RUSSELL BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1220 N DIVISION ST, FORREST CITY, AR 72335-2307
(870) 633-4219
(870) 633-4120
Mailing address
1220 N DIVISION ST, FORREST CITY, AR 72335-2307
(870) 633-4219
(870) 633-4120
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2380
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103180608
—
AR
Enumeration date
01/25/2010
Last updated
01/25/2010
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