Provider Demographics
NPI:1295864130
Name:GRODER, BARRY DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:DENNIS
Last Name:GRODER
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 1:9819 HALDEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-2312
Mailing Address - Country:US
Mailing Address - Phone:215-677-6951
Mailing Address - Fax:
Practice Address - Street 1:9819 HALDEMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-2312
Practice Address - Country:US
Practice Address - Phone:215-677-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021538L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice