Provider Demographics
NPI:1942205075
Name:BADE, BARRY KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:KENT
Last Name:BADE
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 1:1408 ARCADIA ST
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-1102
Mailing Address - Country:US
Mailing Address - Phone:573-581-5762
Mailing Address - Fax:
Practice Address - Street 1:201 E MONROE ST
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-2852
Practice Address - Country:US
Practice Address - Phone:573-581-4352
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist