Healthcare Provider Details

I. General information

NPI: 1508828732
Provider Name (Legal Business Name): BARRY FRANK BOOTH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6475 SPANISH FORT BLVD SUITE H
SPANISH FORT AL
36527-9406
US

IV. Provider business mailing address

PO BOX 7700
SPANISH FORT AL
36577-7700
US

V. Phone/Fax

Practice location:
  • Phone: 251-654-1563
  • Fax:
Mailing address:
  • Phone: 251-654-1563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberLND5269
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: