Provider Demographics
NPI:1427115989
Name:MARK, BARRY M (DDS, LAC, CAC)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:M
Last Name:MARK
Suffix:
Gender:M
Credentials:DDS, LAC, CAC
Other - Prefix:DR
Other - First Name:BARRY
Other - Middle Name:M
Other - Last Name:MARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, LAC, CAC
Mailing Address - Street 1:187 PINE ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4527
Mailing Address - Country:US
Mailing Address - Phone:845-334-9340
Mailing Address - Fax:845-334-9343
Practice Address - Street 1:187 PINE ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4527
Practice Address - Country:US
Practice Address - Phone:845-334-9340
Practice Address - Fax:845-334-9343
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032220122300000X
NY000741171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDIH571Medicare ID - Type UnspecifiedPROVIDER NUMBER