Provider Demographics
NPI:1114390705
Name:PHILLIP M BARRON DDS, PLLC
Entity Type:Organization
Organization Name:PHILLIP M BARRON DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-732-1626
Mailing Address - Street 1:4200 BRYANT IRVIN RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4287
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 BRYANT IRVIN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-4287
Practice Address - Country:US
Practice Address - Phone:817-732-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty