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General NPI Number Information
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NPI Number | 1124393434
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Entity Type | Organization
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Legal Business Name | BARRY G ACKER DDS PA
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 03/20/2012
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Provider Practice Location Address
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Address Line | 3100 NEW COPELAND RD
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City | TYLER
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State | TX
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Zip | 75701-7940
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Country | US
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Telephone | 903-597-2848
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Fax | 903-593-9626
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Provider Business Mailing Address
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Address Line | 3100 NEW COPELAND RD
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City | TYLER
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State | TX
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Zip | 75701-7940
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Country | US
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Telephone | 903-597-2848
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Fax | 903-593-9626
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | BARRY G ACKER
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Credential |
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Telephone | 903-597-2848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 8636
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License Number State | TX
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