Provider Demographics
NPI:1467545111
Name:BARRY LEE BOOTH, D.M.D., P.C.
Entity Type:Organization
Organization Name:BARRY LEE BOOTH, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-626-3211
Mailing Address - Street 1:PO BOX 7406
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36577-7406
Mailing Address - Country:US
Mailing Address - Phone:251-626-3211
Mailing Address - Fax:251-625-0211
Practice Address - Street 1:6525 SPANISH FORT BLVD
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527
Practice Address - Country:US
Practice Address - Phone:251-626-3211
Practice Address - Fax:251-625-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty