Healthcare Provider Details

I. General information

NPI: 1033280045
Provider Name (Legal Business Name): THOMAS R BARKER JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOPKINS AVENUE
DANVILLE WV
25053-0257
US

IV. Provider business mailing address

PO BOX 257
DANVILLE WV
25053-0257
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1614
  • Fax:
Mailing address:
  • Phone: 304-369-1614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1819
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: