Healthcare Provider Details

I. General information

NPI: 1033160486
Provider Name (Legal Business Name): BARRY F DAROCHA DMD, MAGD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N KESWICK AVE
GLENSIDE PA
19038-4804
US

IV. Provider business mailing address

230 N KESWICK AVE
GLENSIDE PA
19038-4804
US

V. Phone/Fax

Practice location:
  • Phone: 215-885-4252
  • Fax: 215-885-7487
Mailing address:
  • Phone: 215-885-4252
  • Fax: 215-885-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS234170
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: