MEDICARE: DR. MARK ALAN BARBER D.D.S.

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	DN10705	FL

General Provider Information

NPI Number	:	1336287804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALAN BARBER D.D.S.

Provider Business Mailing Address
First Line	:	718 SE BECKER RD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-6621
Country	:	US
Telephone Number	:	772-336-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 SE BECKER RD
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34984-6621
Country	:	US
Telephone Number	:	772-336-2300
Fax Number	:

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

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	10/06/2008

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