Provider Demographics
NPI:1255334801
Name:BARRA, ELIZABETH CAMERON (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CAMERON
Last Name:BARRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1726
Mailing Address - Country:US
Mailing Address - Phone:518-786-0979
Mailing Address - Fax:518-465-7409
Practice Address - Street 1:1070 LOUDON ROAD
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047
Practice Address - Country:US
Practice Address - Phone:518-786-0979
Practice Address - Fax:518-786-0627
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040728-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice