Provider Demographics
NPI:1851416978
Name:BARR, BRUCE KENNETH (DDS, PC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:KENNETH
Last Name:BARR
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 GREENTREE ARCH
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-3787
Mailing Address - Country:US
Mailing Address - Phone:757-422-0005
Mailing Address - Fax:757-437-1062
Practice Address - Street 1:1369 LASKIN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6080
Practice Address - Country:US
Practice Address - Phone:757-422-0005
Practice Address - Fax:757-437-1062
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA0401-0055551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics