Provider Demographics
NPI:1003229899
Name:BARRY, REZA MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:MICHAEL
Last Name:BARRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 RESERVE DR
Mailing Address - Street 2:APT 2623
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-8200
Mailing Address - Country:US
Mailing Address - Phone:850-241-2868
Mailing Address - Fax:
Practice Address - Street 1:3051 HIGHLAND OAKS TER
Practice Address - Street 2:SUITE 4
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3845
Practice Address - Country:US
Practice Address - Phone:850-656-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN208851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics