Provider Demographics
NPI:1578894424
Name:NESTLERODE, BARRY (DR)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:NESTLERODE
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7531 N CLEARWATER PKWY
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2823
Mailing Address - Country:US
Mailing Address - Phone:480-695-6056
Mailing Address - Fax:
Practice Address - Street 1:7125 E LINCOLN DR STE 212
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-4429
Practice Address - Country:US
Practice Address - Phone:480-483-8067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ4495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist