Katherine E Berry, RDH
Individual provider Active NPI Dental Hygienist · Dulce, NM
NPI 1194834242 · NPPES record last updated Jun 3, 2008
Key facts
- NPI
- 1194834242
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 532 (WY)
- Practice address
- 12000 Stone Lake Rd
Jicarilla Apache Health Care Facility, IHS
Dulce, NM 87528-0000 - Phone
- (575) 759-3291
- Fax
- (575) 759-3651
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 532 | WY | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS/IHS/Aao/Jsu/Dulce Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 532 | WY | Yes |
Addresses
Primary practice location
12000 Stone Lake Rd
Jicarilla Apache Health Care Facility, IHS
Dulce, NM 87528-0000
Mailing address
PO Box 220
Dulce, NM 87528-0220
Phone (575) 759-0062
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSZ196 | Other | NM | MEDICARE PART B |
| 000K3526 | Medicaid | NM |
Other providers in Dulce, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.