Healthcare Provider Details

I. General information

NPI: 1639199433
Provider Name (Legal Business Name): BARRY L HOLDEN DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 REGENT CT STE 100
STATE COLLEGE PA
16801-7966
US

IV. Provider business mailing address

110 REGENT CT STE 100
STATE COLLEGE PA
16801-7966
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-0110
  • Fax: 814-231-0118
Mailing address:
  • Phone: 814-231-0110
  • Fax: 814-231-0118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDS024069L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDS024069L
License Number StatePA

VIII. Authorized Official

Name: DR. BARRY LEE HOLDEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 814-231-0110