Healthcare Provider Details

I. General information

NPI: 1255334801
Provider Name (Legal Business Name): ELIZABETH CAMERON BARRA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 LOUDON ROAD
COHOES NY
12047
US

IV. Provider business mailing address

410 LOUDON RD
LOUDONVILLE NY
12211-1726
US

V. Phone/Fax

Practice location:
  • Phone: 518-786-0979
  • Fax: 518-786-0627
Mailing address:
  • Phone: 518-786-0979
  • Fax: 518-465-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number040728-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: