Michael David Barry, D.D.S.
Individual provider Active NPI General Practice Dentistry · Clinton, LA
NPI 1639399264 · NPPES record last updated Aug 2, 2018
Key facts
- NPI
- 1639399264
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3648 (LA)
- Practice address
- 11990 Jackson St
Clinton, LA 70722 - Phone
- (225) 683-5292
- Fax
- (225) 683-3411
- NPI assigned
- Apr 26, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180904003046 | LA | Order and Referring Only - Dentist |
2163772674 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3648 | LA | Yes |
Addresses
Primary practice location
11990 Jackson St
Clinton, LA 70722
Mailing address
P.O. Box 378
Grand Coteau, LA 70541
Phone (337) 207-7556
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1836486 | Medicaid | LA |
Other providers in Clinton, LA
- Marie M Attuso
- Jenise Nate Aydell-Hontiveros
- Kelly Bankston
- Kelli R Barbay
- Christina Hamilton Barrett
- Urhonda Beckwith
- Beante Y Beverly-Holmes
- Bettie Blackmon
- Latoya Monique Branch
- Karla V Bringedahl
All providers in Clinton, LA · General Practice Dentistry in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.