Provider Demographics
NPI:1326194986
Name:STAHL, BARRY W (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:W
Last Name:STAHL
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:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42206-0609
Mailing Address - Country:US
Mailing Address - Phone:270-542-7381
Mailing Address - Fax:
Practice Address - Street 1:104 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206
Practice Address - Country:US
Practice Address - Phone:270-542-7381
Practice Address - Fax:270-542-7381
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY65391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60065398Medicaid