Provider Demographics
NPI:1255463410
Name:BARRON, BRIAN CASSIDY (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CASSIDY
Last Name:BARRON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 112TH AVE NE STE F
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5807
Mailing Address - Country:US
Mailing Address - Phone:425-454-1975
Mailing Address - Fax:425-454-1975
Practice Address - Street 1:121 112TH AVE NE STE F
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5807
Practice Address - Country:US
Practice Address - Phone:425-454-1975
Practice Address - Fax:425-454-1975
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10901223G0001X
FL17785122300000X
WADE 60161571122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice