Provider Demographics
NPI:1821330945
Name:BARRY, RON JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:JOHN
Last Name:BARRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13983 MANGO DR.
Mailing Address - Street 2:#202
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3152
Mailing Address - Country:US
Mailing Address - Phone:858-755-7118
Mailing Address - Fax:
Practice Address - Street 1:13983 MANGO DR.
Practice Address - Street 2:#202
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3152
Practice Address - Country:US
Practice Address - Phone:858-755-7118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist