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General NPI Number Information
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NPI Number | 1336502210
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Entity Type | Organization
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Legal Business Name | BARRY SPORER DMD PC
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 05/08/2025
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Provider Practice Location Address
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Address Line | 80 PARK AVENUE STE 1C
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City | NEW YORK
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State | NY
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Zip | 10016-2542
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Country | US
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Telephone | 212-697-5988
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Fax | 212-986-8305
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Provider Business Mailing Address
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Address Line | 80 PARK AVENUE STE 1C
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City | NEW YORK
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State | NY
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Zip | 10016-2542
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Country | US
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Telephone | 212-697-5988
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Fax | 212-986-8305
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Authorized Official
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Title or Position | SENIOR CREDENTIALING TEAM LEAD
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Name | JENNY GARCIA-ROCHA
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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