=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386662799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES LYNN BARBER D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1315 W GORE BLVD
-----------------------------------------------------
City | LAWTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73501-3605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-357-6981
-----------------------------------------------------
Fax | 580-357-6992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | RR 2 BOX 39
-----------------------------------------------------
City | COMANCHE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73529-9609
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-439-5349
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 4338
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------