Healthcare Provider Details

I. General information

NPI: 1831539832
Provider Name (Legal Business Name): BARRINGTON ONEAL ANDERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 07/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 GLENWOOD PRISM DENTAL PC
BROOKLYN NY
11210
US

IV. Provider business mailing address

3304 GLENWOOD RD PRISM DENTAL PC
BROOKLYN NY
11210
US

V. Phone/Fax

Practice location:
  • Phone: 718-434-3900
  • Fax: 718-434-4603
Mailing address:
  • Phone: 718-434-3900
  • Fax: 718-434-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number045191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: