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General NPI Number Information
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NPI Number | 1487843801
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Entity Type | Individual
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Provider Name | DR. MARTIN THOMAS BARCO III
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Gender | Male
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Dates
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Enumeration Date | 10/22/2007
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 615 N WALNUT ST
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City | BLOOMINGTON
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State | IN
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Zip | 47404-3811
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Country | US
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Telephone | 812-332-8290
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 WISHARD BLVD # R4201 DEPARTMENT OF ORAL SURGERY AND HOSPITAL DENTISTRY IUPUI
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-2872
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Country | US
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Telephone | 317-312-0890
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 120011246A
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License Number State | IN
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