Healthcare Provider Details

I. General information

NPI: 1689670713
Provider Name (Legal Business Name): IAN BARWICK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 LAKEVIEW AVE
DRACUT MA
01826-3414
US

IV. Provider business mailing address

1345 LAKEVIEW AVE
DRACUT MA
01826-3414
US

V. Phone/Fax

Practice location:
  • Phone: 978-957-5511
  • Fax: 978-957-6419
Mailing address:
  • Phone: 978-957-5511
  • Fax: 978-957-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14250
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: