Provider Demographics
NPI:1053451146
Name:DENNIS BARBER SHOP
Entity Type:Organization
Organization Name:DENNIS BARBER SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PECORELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-447-4927
Mailing Address - Street 1:1007 ALAMO DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5603
Mailing Address - Country:US
Mailing Address - Phone:707-447-4927
Mailing Address - Fax:707-447-2529
Practice Address - Street 1:1007 ALAMO DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5603
Practice Address - Country:US
Practice Address - Phone:707-447-4927
Practice Address - Fax:707-447-2529
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENNIS PECORELLA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA181199332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65425ZOtherBLUE SHIELD PIN