Provider Demographics
NPI:1972768000
Name:BARBARA BROUGH, D D S, P A
Entity type:Organization
Organization Name:BARBARA BROUGH, D D S, P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-883-3993
Mailing Address - Street 1:735 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78408-2840
Mailing Address - Country:US
Mailing Address - Phone:361-883-3993
Mailing Address - Fax:361-882-1048
Practice Address - Street 1:735 OAK PARK AVENUE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408-2840
Practice Address - Country:US
Practice Address - Phone:361-883-3993
Practice Address - Fax:361-882-1048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty