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General NPI Number Information
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NPI Number | 1902912355
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Entity Type | Individual
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Provider Name | BARRY DEAN HOTHERSALL DMD
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 943 S BENEVA RD SUITE 110
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City | SARASOTA
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State | FL
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Zip | 34232
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Country | US
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Telephone | 941-365-7116
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Fax | 941-365-7116
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Provider Business Mailing Address
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Address Line | 943 S BENEVA RD SUITE 110
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City | SARASOTA
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State | FL
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Zip | 34232
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Country | US
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Telephone | 941-365-7116
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Fax | 941-365-7215
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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 | 2800
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN11095
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License Number State | FL
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