Provider Demographics
NPI:1881745107
Name:BROUGH, BARBARA RUTH (DDS)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:RUTH
Last Name:BROUGH
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 1:735 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78408-2840
Mailing Address - Country:US
Mailing Address - Phone:361-883-3993
Mailing Address - Fax:361-882-1048
Practice Address - Street 1:735 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408-2840
Practice Address - Country:US
Practice Address - Phone:361-883-3993
Practice Address - Fax:361-882-1048
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice