Provider Demographics
NPI:1356614135
Name:BARRY FRANK BOOTH DMD LLC
Entity type:Organization
Organization Name:BARRY FRANK BOOTH DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-654-1563
Mailing Address - Street 1:PO BOX 7700
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36577-7700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6475 SPANISH FORT BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-9406
Practice Address - Country:US
Practice Address - Phone:251-654-1563
Practice Address - Fax:251-625-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5269261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental