Provider Demographics
NPI:1710103312
Name:BARCONEY, LINDA SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUSAN
Last Name:BARCONEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:345 E MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1814
Mailing Address - Country:US
Mailing Address - Phone:310-672-7822
Mailing Address - Fax:310-330-0722
Practice Address - Street 1:345 E MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1814
Practice Address - Country:US
Practice Address - Phone:310-672-7822
Practice Address - Fax:310-330-0722
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry