Provider Demographics
NPI:1912109307
Name:BARRAS, BROCK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:
Last Name:BARRAS
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 1:1700 KALISTE SALOOM RD
Mailing Address - Street 2:BLDG 4
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6186
Mailing Address - Country:US
Mailing Address - Phone:337-235-3395
Mailing Address - Fax:337-234-5789
Practice Address - Street 1:1700 KALISTE SALOOM RD
Practice Address - Street 2:BLDG 4
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6186
Practice Address - Country:US
Practice Address - Phone:337-235-3395
Practice Address - Fax:337-234-5789
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA56221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice