Provider Demographics
NPI:1235358482
Name:PORTNOY, BARRY RICHARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:RICHARD
Last Name:PORTNOY
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 1:18 LYMAN ST
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1459
Mailing Address - Country:US
Mailing Address - Phone:508-366-1700
Mailing Address - Fax:
Practice Address - Street 1:18 LYMAN ST
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1459
Practice Address - Country:US
Practice Address - Phone:508-366-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA129071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice