Provider Demographics
NPI:1780691345
Name:BARRON, SUE ANNE (DDS)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ANNE
Last Name:BARRON
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 1:990 SOUTH AVE
Mailing Address - Street 2:SUITE 020
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2740
Mailing Address - Country:US
Mailing Address - Phone:585-341-6888
Mailing Address - Fax:585-341-6966
Practice Address - Street 1:990 SOUTH AVE
Practice Address - Street 2:SUITE 020
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2740
Practice Address - Country:US
Practice Address - Phone:585-341-6888
Practice Address - Fax:585-341-6966
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0421191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYHG7221OtherEMPLOYER'S BC/BS NUMBER
NY00354307Medicaid