Healthcare Provider Details

I. General information

NPI: 1154598175
Provider Name (Legal Business Name): BRIAN THOMAS BARKER D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 S VICTORIA AVE SUITE 302
VENTURA CA
93003-6507
US

IV. Provider business mailing address

1190 S VICTORIA AVE SUITE 302
VENTURA CA
93003-6507
US

V. Phone/Fax

Practice location:
  • Phone: 805-639-8801
  • Fax: 805-639-4077
Mailing address:
  • Phone: 805-639-8801
  • Fax: 805-639-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS037341
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number55666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: