Jordan Berry
Individual provider Active NPI Dental Hygienist · Macon, MO
NPI 1891145975 · NPPES record last updated Jun 20, 2016
Key facts
- NPI
- 1891145975
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 2015016912 (MO)
- Practice address
- 209 N Missouri St
Macon, MO 63552-2151 - Phone
- (660) 395-5045
- NPI assigned
- Jun 20, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| 2015016912 | MO | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2015016912 | MO | Yes |
Addresses
Primary practice location
209 N Missouri St
Macon, MO 63552-2151
Mailing address
1416 Crown Dr
Kirksville, MO 63501-2548
Phone (660) 627-5757
Other providers in Macon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2016. 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.