Provider Demographics
NPI:1568030203
Name:BARSOTTI, PHILIP BURKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:BURKE
Last Name:BARSOTTI
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 1:412 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2007
Mailing Address - Country:US
Mailing Address - Phone:859-236-6181
Mailing Address - Fax:
Practice Address - Street 1:412 S 4TH ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2007
Practice Address - Country:US
Practice Address - Phone:859-236-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice