Provider Demographics
NPI:1841376191
Name:BARR, DOUGLAS M (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:M
Last Name:BARR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 PLAZA DRIVE STE B
Mailing Address - Street 2:
Mailing Address - City:SO SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776
Mailing Address - Country:US
Mailing Address - Phone:402-494-2144
Mailing Address - Fax:402-494-3002
Practice Address - Street 1:3220 PLAZA DRIVE STE B
Practice Address - Street 2:
Practice Address - City:SO SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776
Practice Address - Country:US
Practice Address - Phone:402-494-2144
Practice Address - Fax:402-494-3002
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE47901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice