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General NPI Number Information
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NPI Number | 1912111782
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Entity Type | Organization
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Legal Business Name | BARRY L BUPP DMD INC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 530 SOUTH ST
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City | GREENSBURG
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State | PA
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Zip | 15601-2775
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Country | US
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Telephone | 724-837-3318
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Fax | 724-837-6975
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Provider Business Mailing Address
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Address Line | 530 SOUTH ST
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City | GREENSBURG
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State | PA
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Zip | 15601-2775
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Country | US
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Telephone | 724-837-3318
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Fax | 724-837-6975
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY L BUPP
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Credential | D.M.D.
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Telephone | 724-837-3318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DS020754L
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License Number State | PA
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