Provider Demographics
NPI:1902912355
Name:HOTHERSALL, BARRY DEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:DEAN
Last Name:HOTHERSALL
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 1:943 S BENEVA RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232
Mailing Address - Country:US
Mailing Address - Phone:941-365-7116
Mailing Address - Fax:941-365-7215
Practice Address - Street 1:943 S BENEVA RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232
Practice Address - Country:US
Practice Address - Phone:941-365-7116
Practice Address - Fax:941-365-7116
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2800122300000X
FLDN110951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
69083Medicare UPIN
69083Medicare ID - Type Unspecified