Healthcare Provider Details

I. General information

NPI: 1548377112
Provider Name (Legal Business Name): MARVIN L BARRON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CHURCH AVENUE RAINSVILLE CLINIC
RAINSVILLE AL
35986-0729
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 Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2212
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: