Healthcare Provider Details

I. General information

NPI: 1881020097
Provider Name (Legal Business Name): DR. MARVIN L. BARRON DENTAL PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CHURCH AVENUE RAINSVILLE CLINIC
RAINSVILLE AL
35986
US

IV. Provider business mailing address

PO BOX 729
RAINSVILLE AL
35986-0729
US

V. Phone/Fax

Practice location:
  • Phone: 256-638-2111
  • Fax: 256-638-6205
Mailing address:
  • Phone: 256-638-2111
  • Fax: 256-638-6205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number97
License Number StateAL

VIII. Authorized Official

Name: DR. MARVIN LEE BARRON
Title or Position: OWNER
Credential: DMD
Phone: 256-638-2111