Provider Demographics
NPI:1508828732
Name:BOOTH, BARRY FRANK (DMD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:FRANK
Last Name:BOOTH
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: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:251-654-1563
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLND5269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515991OtherBCBS
AL631400138Medicaid
AL631400138Medicaid
AL51515991OtherBCBS