Provider Demographics
NPI:1689682726
Name:BRODY, BARRY ALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:ALVIN
Last Name:BRODY
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 1:750 ROUTE 73 S
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4141
Mailing Address - Country:US
Mailing Address - Phone:856-983-2232
Mailing Address - Fax:856-983-6111
Practice Address - Street 1:750 ROUTE 73 S
Practice Address - Street 2:SUITE 102A
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4141
Practice Address - Country:US
Practice Address - Phone:856-983-2232
Practice Address - Fax:856-983-6111
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ91261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice