Healthcare Provider Details

I. General information

NPI: 1467545111
Provider Name (Legal Business Name): BARRY LEE BOOTH, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6525 SPANISH FORT BLVD
SPANISH FORT AL
36527
US

IV. Provider business mailing address

PO BOX 7406
SPANISH FORT AL
36577-7406
US

V. Phone/Fax

Practice location:
  • Phone: 251-626-3211
  • Fax: 251-625-0211
Mailing address:
  • Phone: 251-626-3211
  • Fax: 251-625-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRY LEE BOOTH
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 251-626-3211