Provider Demographics
NPI:1598918930
Name:BARRON, RUSSELL ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALLEN
Last Name:BARRON
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:PO BOX 819
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-0819
Mailing Address - Country:US
Mailing Address - Phone:360-629-2420
Mailing Address - Fax:360-629-7211
Practice Address - Street 1:9619 271ST ST NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-0819
Practice Address - Country:US
Practice Address - Phone:360-629-2420
Practice Address - Fax:360-629-7211
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00003899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8004236Medicaid
WA8924064OtherL&I CRIME VICTIMS PROVIDER #
WA5320205Medicaid
WA0151502OtherL&I REGULAR PROVIDER #