Provider Demographics
NPI:1710101639
Name:BARRY, SHAWN
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:BARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 MAIN ST
Mailing Address - Street 2:STE 142
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-7915
Mailing Address - Country:US
Mailing Address - Phone:970-686-6661
Mailing Address - Fax:
Practice Address - Street 1:1550 MAIN ST
Practice Address - Street 2:STE 142
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-7915
Practice Address - Country:US
Practice Address - Phone:970-686-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO83671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice