Individual
JORDAN ANTHONY BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
675 WACHESAW RD UNIT C, MURRELLS INLET, SC 29576-5681
(843) 230-7495
Mailing address
4006 GRAY HERON DR, NORTH MYRTLE BEACH, SC 29582-9547
(843) 230-7495
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8800
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/07/2016
Last updated
04/25/2018
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