Provider Demographics
NPI:1417052507
Name:BARHAM, ROBERT G (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:BARHAM
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 1:215 SOUTH BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950
Mailing Address - Country:US
Mailing Address - Phone:256-878-8804
Mailing Address - Fax:256-878-8832
Practice Address - Street 1:215 S BROAD STREET
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950
Practice Address - Country:US
Practice Address - Phone:256-878-8804
Practice Address - Fax:256-878-8832
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice