Provider Demographics
NPI:1285807271
Name:KEVIN R BARRY DDS
Entity type:Organization
Organization Name:KEVIN R BARRY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-421-4824
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:STE 701
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-421-4824
Mailing Address - Fax:415-421-2765
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:STE 701
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-421-4824
Practice Address - Fax:415-421-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty