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General NPI Number Information
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NPI Number | 1093854481
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Entity Type | Individual
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Provider Name | DR. JASON D BARLOCK
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8595 COLLEGE PKWY SUITE B-5
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City | FORT MYERS
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State | FL
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Zip | 33919-5191
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Country | US
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Telephone | 239-433-0921
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Fax |
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Provider Business Mailing Address
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Address Line | 15241 CORTONA WAY
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City | NAPLES
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State | FL
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Zip | 34120-0673
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Country | US
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Telephone | 239-776-4633
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN15803
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License Number State | FL
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