Provider Demographics
NPI:1407975188
Name:BINGHAM, BARRY V (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:V
Last Name:BINGHAM
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 1:1303 S LAUREL RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8304
Mailing Address - Country:US
Mailing Address - Phone:606-877-2700
Mailing Address - Fax:606-877-9190
Practice Address - Street 1:1303 S LAUREL RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-8304
Practice Address - Country:US
Practice Address - Phone:606-877-2700
Practice Address - Fax:606-877-9190
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60062783Medicaid