Healthcare Provider Details

I. General information

NPI: 1225005473
Provider Name (Legal Business Name): BRENT L BARKER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 1ST.
WANBLEE SD
57577
US

IV. Provider business mailing address

210 1ST.
WANBLEE SD
57577
US

V. Phone/Fax

Practice location:
  • Phone: 605-462-6155
  • Fax: 605-462-6551
Mailing address:
  • Phone: 605-462-6155
  • Fax: 605-462-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberM938
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: