Provider Demographics
NPI:1497832307
Name:BARRY, CHRISTINE Y (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:Y
Last Name:BARRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-764-0502
Mailing Address - Fax:206-764-0516
Practice Address - Street 1:1412 NE 88TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-9620
Practice Address - Country:US
Practice Address - Phone:360-574-4074
Practice Address - Fax:360-574-4074
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000080141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5027594Medicaid
WA0175782OtherSTATE LABOR & INDUSTRIES
WA5524LOOtherREGENCE BLUE SHIELD