Healthcare Provider Details

I. General information

NPI: 1174882955
Provider Name (Legal Business Name): PHILLIP CHARLES BARRAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 MEDICAL GROUP UNIT 5071
APO AP
96328
US

IV. Provider business mailing address

52 MDG UNIT 3690
APO AE
09126
US

V. Phone/Fax

Practice location:
  • Phone: 314-225-3671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number019.029068
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.029068
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: