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NPI Code Detail

MEDICARE: HARGROW DEXTER BARBER DDS

MEDICARE:   HARGROW DEXTER BARBER  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223S0112XOral and Maxillofacial Surgery (Dentist)DS027665LPA
21223S0112XOral and Maxillofacial Surgery (Dentist)22DI020061NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003804279
Entity Type Code : Individual
Provider Name (Legal Business Name) : HARGROW DEXTER BARBER DDS
Provider Business Mailing Address
First Line : 6601 S RURAL RD
Second Line : SOUTHWEST DENTAL GROUP
City : TEMPE
State : AZ
Zip : 85283-3747
Country : US
Telephone Number : 480-456-0821
Fax Number :
Provider Business Practice Location Address
First Line : 100 E LEHIGH AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19125-1000
Country : US
Telephone Number : 215-707-3613
Fax Number : 215-707-5405
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 07/20/2009

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Directions to “ HARGROW DEXTER BARBER DDS” Practice Location

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