Provider Demographics
NPI:1497862544
Name:BARROWS, BRYANT KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:KEITH
Last Name:BARROWS
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 1:400 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MC RAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-1760
Mailing Address - Country:US
Mailing Address - Phone:229-868-4462
Mailing Address - Fax:
Practice Address - Street 1:400 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:MC RAE
Practice Address - State:GA
Practice Address - Zip Code:31055-1760
Practice Address - Country:US
Practice Address - Phone:229-868-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN011215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN011215OtherSTATE LICENSE