Provider Demographics
NPI:1528123890
Name:FOUTZ, BARTON HUMPHRIES (DDS)
Entity type:Individual
Prefix:
First Name:BARTON
Middle Name:HUMPHRIES
Last Name:FOUTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 WIGWAM PKWY
Mailing Address - Street 2:SUITE #100
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7114
Mailing Address - Country:US
Mailing Address - Phone:702-792-5929
Mailing Address - Fax:702-792-2850
Practice Address - Street 1:2510 WIGWAM PKWY
Practice Address - Street 2:SUITE #100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7114
Practice Address - Country:US
Practice Address - Phone:702-792-5929
Practice Address - Fax:702-792-2850
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV23251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice