Healthcare Provider Details

I. General information

NPI: 1275894586
Provider Name (Legal Business Name): BARRY SHIPMAN DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NE 167TH ST 208
NORTH MIAMI BEACH FL
33162-3711
US

IV. Provider business mailing address

10180 W BAY HARBOR DR 5 C
BAY HARBOR ISLANDS FL
33154-1292
US

V. Phone/Fax

Practice location:
  • Phone: 305-864-5557
  • Fax:
Mailing address:
  • Phone: 305-864-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN5056
License Number StateFL

VIII. Authorized Official

Name: DR. BARRY SHIPMAN
Title or Position: PRESIDEENT
Credential: DMD
Phone: 305-864-5557