Healthcare Provider Details

I. General information

NPI: 1851416978
Provider Name (Legal Business Name): BRUCE KENNETH BARR D.D.S., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1369 LASKIN RD
VIRGINIA BEACH VA
23451-6080
US

IV. Provider business mailing address

845 GREENTREE ARCH
VIRGINIA BEACH VA
23451-3787
US

V. Phone/Fax

Practice location:
  • Phone: 757-422-0005
  • Fax: 757-437-1062
Mailing address:
  • Phone: 757-422-0005
  • Fax: 757-437-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberVA0401-005555
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: