Provider Demographics
NPI:1699141366
Name:BARRON, PHILLIP M (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:M
Last Name:BARRON
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 1:4200 BRYANT IRVIN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4287
Mailing Address - Country:US
Mailing Address - Phone:817-732-1626
Mailing Address - Fax:
Practice Address - Street 1:4200 BRYANT IRVIN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-4287
Practice Address - Country:US
Practice Address - Phone:817-732-1626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist