Provider Demographics
NPI:1215152715
Name:DALE, BARRY GERALD (DMD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:GERALD
Last Name:DALE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 PHELPS AVE
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2819
Mailing Address - Country:US
Mailing Address - Phone:201-569-7361
Mailing Address - Fax:201-569-7629
Practice Address - Street 1:19 PHELPS AVE
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2819
Practice Address - Country:US
Practice Address - Phone:201-569-7361
Practice Address - Fax:201-569-7629
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011301001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice