Healthcare Provider Details

I. General information

NPI: 1992834741
Provider Name (Legal Business Name): BARKLEY LOW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7176 SANTA TERESA BLVD SUITE B5
SAN JOSE CA
95139-1351
US

IV. Provider business mailing address

7176 SANTA TERESA BLVD SUITE B5
SAN JOSE CA
95139-1351
US

V. Phone/Fax

Practice location:
  • Phone: 408-225-6275
  • Fax: 408-225-1459
Mailing address:
  • Phone: 408-225-6275
  • Fax: 408-225-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number24679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: