Provider Demographics
NPI:1649247891
Name:BRUYERE, BARRY CLINTON (DDS)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:CLINTON
Last Name:BRUYERE
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 1:806 MEDICAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5110
Mailing Address - Country:US
Mailing Address - Phone:903-753-0337
Mailing Address - Fax:903-236-4537
Practice Address - Street 1:806 MEDICAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5110
Practice Address - Country:US
Practice Address - Phone:903-753-0337
Practice Address - Fax:903-236-4537
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice