MEDICARE: DR. JOHN M. BAARCKE D.M.D

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
1	1223G0001X	General Practice Dentistry	2090	SC

General Provider Information

NPI Number	:	1053313130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M. BAARCKE D.M.D

Provider Business Mailing Address
First Line	:	PO BOX 892
Second Line	:
City	:	UNION
State	:	SC
Zip	:	29379-0892
Country	:	US
Telephone Number	:	864-427-9721
Fax Number	:	864-427-9726

Provider Business Practice Location Address
First Line	:	434 DUNCAN BYPASS
Second Line	:
City	:	UNION
State	:	SC
Zip	:	29379
Country	:	US
Telephone Number	:	864-427-9721
Fax Number	:	864-427-9726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	07/08/2007

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