Provider Demographics
NPI:1831134089
Name:BARRY, TIMOTHY MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:BARRY
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 1:411 NICHOLS RD
Mailing Address - Street 2:SUITE 241
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2000
Mailing Address - Country:US
Mailing Address - Phone:816-561-2800
Mailing Address - Fax:816-561-4574
Practice Address - Street 1:411 NICHOLS RD
Practice Address - Street 2:SUITE 241
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2000
Practice Address - Country:US
Practice Address - Phone:816-561-2800
Practice Address - Fax:816-561-4574
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO132941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO08375015OtherBLUE CROSS BLUE SHIELD
MOTMB9291953Medicaid