Provider Demographics
NPI:1376795393
Name:HOLDEN, BARRY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:HOLDEN
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 1:110 REGENT CT
Mailing Address - Street 2:SUITE #100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7966
Mailing Address - Country:US
Mailing Address - Phone:814-231-0110
Mailing Address - Fax:814-231-0118
Practice Address - Street 1:110 REGENT CT
Practice Address - Street 2:SUITE #100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7966
Practice Address - Country:US
Practice Address - Phone:814-231-0110
Practice Address - Fax:814-231-0118
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024069L1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA411542OtherBLUE CROSS/BLUE SHIELD
PA411542OtherUNITED CONCORDIA
PA411542Medicare PIN
PA411542Medicare Oscar/Certification
PA411542OtherBLUE CROSS/BLUE SHIELD