Provider Demographics
NPI:1578950325
Name:KAREN BERRIGAN DMD, MS, PC
Entity type:Organization
Organization Name:KAREN BERRIGAN DMD, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:BERRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-931-4386
Mailing Address - Street 1:20100 N 51ST AVE STE B230
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-5097
Mailing Address - Country:US
Mailing Address - Phone:623-931-4386
Mailing Address - Fax:623-930-0491
Practice Address - Street 1:20100 N 51ST AVE STE B230
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-5097
Practice Address - Country:US
Practice Address - Phone:623-931-4386
Practice Address - Fax:623-930-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3549261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental