Healthcare Provider Details

I. General information

NPI: 1124519558
Provider Name (Legal Business Name): MICHAEL AZIZ BARBER D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E 149TH ST
BRONX NY
10451
US

IV. Provider business mailing address

240 GEIGER RD
PHILADELPHIA PA
19115-1008
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5692
  • Fax:
Mailing address:
  • Phone: 215-677-0380
  • Fax: 215-969-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS041923
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS041923
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: