Active NPI
John Chester Berry Jr, DDS
- General Practice Dentistry
- Durham, NC
National Provider Identifier
1760426159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4425
- Practice address
- 632 Gary St
Durham, NC 27703-2202 - Phone
- (919) 682-4861
- Fax
- (919) 688-4861
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 4425 | NC | Primary |
Addresses
Primary practice location
632 Gary St
Durham, NC 27703-2202
Mailing address
632 Gary St
Durham, NC 27703-2202
Phone (919) 682-4861
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D402554 | Other | NC | CIGNA |
| 111150 | Other | NC | AETNA PROVIDER NUMBER |
| 8990679 | Medicaid | NC | |
| 90679 | Other | NC | BLUE CROSS PROVIDER NUMBE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4425 | NC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kwame a. Gyampo DDS PLLC | Past | Accepting new patients | |
| S. Gibree, D.M.D., P.C. | General Practice | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Durham, NC
- NPI 1801413802
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1760426159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "632 GARY ST",
"city": "DURHAM",
"state": "NC",
"postal_code": "277032202",
"telephone_number": "919-682-4861",
"fax_number": "919-688-4861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "632 GARY ST",
"city": "DURHAM",
"state": "NC",
"postal_code": "277032202",
"telephone_number": "919-682-4861",
"fax_number": "919-688-4861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERRY JR",
"first_name": "JOHN",
"middle_name": "CHESTER",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "4425",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "D402554",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROVIDER NUMBER",
"identifier": "111150",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8990679",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER NUMBE",
"identifier": "90679",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.