Healthcare Provider Details

I. General information

NPI: 1841302163
Provider Name (Legal Business Name): JUDITH BROOKE BARHAM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MILLER ST
WINSTON SALEM NC
27103-2508
US

IV. Provider business mailing address

165 VIRGINIA ST UNIT #303
MOUNT AIRY NC
27030-3866
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2183
  • Fax:
Mailing address:
  • Phone: 336-710-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7585
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: