Healthcare Provider Details

I. General information

NPI: 1114009255
Provider Name (Legal Business Name): MICHAEL W. BARBA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 4TH ST SE SUITE A
MASON CITY IA
50401-4437
US

IV. Provider business mailing address

1453 4TH ST SE SUITE A
MASON CITY IA
50401-4437
US

V. Phone/Fax

Practice location:
  • Phone: 641-423-2172
  • Fax: 641-421-4166
Mailing address:
  • Phone: 641-423-2172
  • Fax: 641-421-4166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number7089
License Number StateIA

VIII. Authorized Official

Name: DR. MICHAEL WAYNE BARBA
Title or Position: OWNER/ORTHODONTIST
Credential: D.D.S., M.S.
Phone: 641-423-2172