Provider Demographics
NPI:1194829697
Name:BAROS, RAYMOND DAVID (DDS)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:DAVID
Last Name:BAROS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 KIVA RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1913
Mailing Address - Country:US
Mailing Address - Phone:719-392-5300
Mailing Address - Fax:719-392-1093
Practice Address - Street 1:513 KIVA RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1913
Practice Address - Country:US
Practice Address - Phone:719-392-5300
Practice Address - Fax:719-392-1093
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1042991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO793766OtherUNITED CONCORDIA
CO71215OtherBLUE CROSS/BLUE SHIELD
CO131423Medicaid
CO104299OtherDELTA DENTAL