Healthcare Provider Details

I. General information

NPI: 1720660251
Provider Name (Legal Business Name): JOHN BARTA DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 MCCASLIN BLVD STE B
LOUISVILLE CO
80027-2914
US

IV. Provider business mailing address

1550 CHAPEL HILLS DR APT E101
COLORADO SPRINGS CO
80920-5417
US

V. Phone/Fax

Practice location:
  • Phone: 810-691-2233
  • Fax:
Mailing address:
  • Phone: 810-691-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN TALBOTT BARTA
Title or Position: DENTIST
Credential: DDS
Phone: 810-691-2233