Provider Demographics
NPI:1417488453
Name:BARIE, SOCORRO
Entity Type:Individual
Prefix:
First Name:SOCORRO
Middle Name:
Last Name:BARIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14887 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2101
Mailing Address - Country:US
Mailing Address - Phone:313-415-6368
Mailing Address - Fax:
Practice Address - Street 1:60 E WARREN AVE FL 2
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1312
Practice Address - Country:US
Practice Address - Phone:313-626-2600
Practice Address - Fax:313-482-9750
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902014742124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist