Provider Demographics
NPI:1407275928
Name:LINDA S. BARCONEY, DDS, INC
Entity Type:Organization
Organization Name:LINDA S. BARCONEY, DDS, INC
Other - Org Name:CHILDREN'S DENTISTRY - LINDA BARCONEY, DDS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARCONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-672-7822
Mailing Address - Street 1:345 E MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1814
Mailing Address - Country:US
Mailing Address - Phone:310-672-7822
Mailing Address - Fax:310-330-0722
Practice Address - Street 1:345 E MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1814
Practice Address - Country:US
Practice Address - Phone:310-672-7822
Practice Address - Fax:310-330-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-11
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29015122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty