=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568989333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BARRE DENTAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2645 MANHATTAN BLVD STE D5
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-3386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-367-0355
-----------------------------------------------------
Fax | 504-229-5203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2645 MANHATTAN BLVD STE D5
-----------------------------------------------------
City | HARVEY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70058-3386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-367-0355
-----------------------------------------------------
Fax | 504-229-5203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BARTON CHARLES BARRE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 504-367-0355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------