Provider Demographics
NPI:1114907839
Name:BLUTH, BARRY ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:ADAM
Last Name:BLUTH
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 1:4175 SW 64TH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3459
Mailing Address - Country:US
Mailing Address - Phone:954-792-3800
Mailing Address - Fax:954-792-3377
Practice Address - Street 1:4175 SW 64TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3459
Practice Address - Country:US
Practice Address - Phone:954-792-3800
Practice Address - Fax:954-792-3377
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL12656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist