Provider Demographics
NPI:1073522173
Name:BARR, GARY S (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:BARR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:705 LANDA ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6172
Mailing Address - Country:US
Mailing Address - Phone:830-625-6914
Mailing Address - Fax:830-629-5530
Practice Address - Street 1:705 LANDA ST
Practice Address - Street 2:SUITE E
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6172
Practice Address - Country:US
Practice Address - Phone:830-625-6914
Practice Address - Fax:830-629-5530
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12084Medicare UPIN
TX00AN77Medicare ID - Type Unspecified