Provider Demographics
NPI:1912111782
Name:BARRY L BUPP DMD INC
Entity Type:Organization
Organization Name:BARRY L BUPP DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUPP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-837-3318
Mailing Address - Street 1:530 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2775
Mailing Address - Country:US
Mailing Address - Phone:724-837-3318
Mailing Address - Fax:724-837-6975
Practice Address - Street 1:530 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2775
Practice Address - Country:US
Practice Address - Phone:724-837-3318
Practice Address - Fax:724-837-6975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020754L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA148094Medicare UPIN