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General NPI Number Information
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NPI Number | 1659485324
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Entity Type | Individual
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Provider Name | JOHN MARK BARRY SR. D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 520 N 12TH ST
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City | RICHMOND
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State | VA
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Zip | 23298-5064
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Country | US
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Telephone | 843-637-0299
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Fax |
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Provider Business Mailing Address
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Address Line | 1423 MADISON CT
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City | MOUNT PLEASANT
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State | SC
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Zip | 29466-7962
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Country | US
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Telephone | 843-792-2142
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Fax | 843-792-3611
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401006853
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License Number State | VA
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