Healthcare Provider Details

I. General information

NPI: 1962426478
Provider Name (Legal Business Name): BARRY HART FRANK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 S DURANGO DR SUITE 2
LAS VEGAS NV
89113-0159
US

IV. Provider business mailing address

5255 S DURANGO DR SUITE 2
LAS VEGAS NV
89113-0159
US

V. Phone/Fax

Practice location:
  • Phone: 702-968-3000
  • Fax: 702-968-3003
Mailing address:
  • Phone: 702-968-3000
  • Fax: 702-968-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS2-30
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: