Healthcare Provider Details

I. General information

NPI: 1720016512
Provider Name (Legal Business Name): JOHN DAVID BARRON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 N BLUFF STREET
GUTTENBERG IA
52052-0584
US

IV. Provider business mailing address

PO BOX 584
GUTTENBERG IA
52052-0584
US

V. Phone/Fax

Practice location:
  • Phone: 563-252-2150
  • Fax:
Mailing address:
  • Phone: 563-252-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6589
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: