Provider Demographics
NPI:1164633343
Name:VLASS, BARRY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:VLASS
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 1:597 W CROSSVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2561
Mailing Address - Country:US
Mailing Address - Phone:770-992-5858
Mailing Address - Fax:770-992-7277
Practice Address - Street 1:597 W CROSSVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2561
Practice Address - Country:US
Practice Address - Phone:770-992-5858
Practice Address - Fax:770-992-7277
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA94831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice