Provider Demographics
NPI:1013112234
Name:BARRY D BRACE, DMD & ASSOCIATES, PC
Entity Type:Organization
Organization Name:BARRY D BRACE, DMD & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-965-6503
Mailing Address - Street 1:469 S KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-6119
Mailing Address - Country:US
Mailing Address - Phone:314-965-6503
Mailing Address - Fax:314-965-7417
Practice Address - Street 1:469 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6119
Practice Address - Country:US
Practice Address - Phone:314-965-6503
Practice Address - Fax:314-965-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO124091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty