Healthcare Provider Details

I. General information

NPI: 1073652608
Provider Name (Legal Business Name): DOUGLAS ROBERT BARDEN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5591 N HOLLYWOOD AVE
WHITEFISH BAY WI
53217-5207
US

IV. Provider business mailing address

5591 N HOLLYWOOD AVE
WHITEFISH BAY WI
53217-5207
US

V. Phone/Fax

Practice location:
  • Phone: 414-962-1281
  • Fax: 414-962-3220
Mailing address:
  • Phone: 414-962-1281
  • Fax: 414-962-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5530
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: