Healthcare Provider Details

I. General information

NPI: 1942205075
Provider Name (Legal Business Name): BARRY KENT BADE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E MONROE ST
MEXICO MO
65265-2852
US

IV. Provider business mailing address

1408 ARCADIA ST
MEXICO MO
65265-1102
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-4352
  • Fax:
Mailing address:
  • Phone: 573-581-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11928
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: