Provider Demographics
NPI:1467679746
Name:FITTS, BARRY SCOTT (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:SCOTT
Last Name:FITTS
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 1:27453 CAPSHAW RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-7511
Mailing Address - Country:US
Mailing Address - Phone:256-216-8525
Mailing Address - Fax:256-216-8527
Practice Address - Street 1:27453 CAPSHAW RD
Practice Address - Street 2:SUITE D
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-7511
Practice Address - Country:US
Practice Address - Phone:256-216-8525
Practice Address - Fax:256-216-8527
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL54931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice