1558485219 NPI number — RUSSELL A. BARRON, DDS, INC, PS

Table of content: (NPI 1558485219)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558485219 NPI number — RUSSELL A. BARRON, DDS, INC, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSSELL A. BARRON, DDS, INC, PS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558485219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STANWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98292-0819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-629-2420
Provider Business Mailing Address Fax Number:
360-629-7211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9619 271ST ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STANWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98292-0819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-629-2420
Provider Business Practice Location Address Fax Number:
360-629-7211
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARRON
Authorized Official First Name:
RUSSELL
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
360-629-2420

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE00003899 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5320205 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0151502 . This is a "L & I REGULAR PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8004236 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8924064 . This is a "L & I CRIME VICTIMS PROV#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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