Provider Demographics
NPI:1396259040
Name:SCOTT L. BARRY, DMD, PC
Entity type:Organization
Organization Name:SCOTT L. BARRY, DMD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-319-4094
Mailing Address - Street 1:9020 SW WASHINGTON SQUARE RD STE 570
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4477
Mailing Address - Country:US
Mailing Address - Phone:503-718-0095
Mailing Address - Fax:
Practice Address - Street 1:9020 SW WASHINGTON SQUARE RD STE 570
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-4477
Practice Address - Country:US
Practice Address - Phone:503-718-0095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD72941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty