Provider Demographics
NPI:1558860759
Name:TOOTHBAR PLLC
Entity Type:Organization
Organization Name:TOOTHBAR PLLC
Other - Org Name:TOOTHBAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-949-8202
Mailing Address - Street 1:211 WALTER SEAHOLM DR # LR160
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-0019
Mailing Address - Country:US
Mailing Address - Phone:512-949-8202
Mailing Address - Fax:
Practice Address - Street 1:211 WALTER SEAHOLM DR # LR160
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-0019
Practice Address - Country:US
Practice Address - Phone:512-949-8202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29096261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental