Provider Demographics
NPI:1598819773
Name:BARFUSS, BRYCE R (DDS)
Entity Type:Individual
Prefix:
First Name:BRYCE
Middle Name:R
Last Name:BARFUSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 CANYON CREST DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5359
Mailing Address - Country:US
Mailing Address - Phone:208-733-9999
Mailing Address - Fax:208-733-9699
Practice Address - Street 1:285 CANYON CREST DR
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5359
Practice Address - Country:US
Practice Address - Phone:208-733-9999
Practice Address - Fax:208-733-9699
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD38921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807190600Medicaid