Healthcare Provider Details

I. General information

NPI: 1699579748
Provider Name (Legal Business Name): SCOTT RYAN BARKER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE # 1
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

397 HALEDON AVE
HALEDON NJ
07508-1551
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-3492
  • Fax:
Mailing address:
  • Phone: 646-474-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03141500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: