Healthcare Provider Details

I. General information

NPI: 1851821920
Provider Name (Legal Business Name): RAYMOND BARRON IV DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MATLOCK CENTRE CIR
ARLINGTON TX
76015-2535
US

IV. Provider business mailing address

PO BOX 1000 DEPT 394
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 817-693-1000
  • Fax: 904-293-4222
Mailing address:
  • Phone: 941-300-4440
  • Fax: 941-404-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: