Provider Demographics
NPI:1609608512
Name:BERRY, GABRIELLE NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:NICOLE
Last Name:BERRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1554
Mailing Address - Country:US
Mailing Address - Phone:614-261-7210
Mailing Address - Fax:
Practice Address - Street 1:4808 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1554
Practice Address - Country:US
Practice Address - Phone:614-261-7210
Practice Address - Fax:614-261-7211
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027579122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty