Provider Demographics
NPI:1548377112
Name:BARRON, MARVIN L (DMD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:L
Last Name:BARRON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-0729
Mailing Address - Country:US
Mailing Address - Phone:256-638-2111
Mailing Address - Fax:256-638-6205
Practice Address - Street 1:103 CHURCH AVENUE
Practice Address - Street 2:RAINSVILLE CLINIC
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-0729
Practice Address - Country:US
Practice Address - Phone:256-638-2111
Practice Address - Fax:256-638-6205
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940030Medicaid