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NPI Code Detail

MEDICARE: DR. RODRICK L BARDEN D.M.D.

MEDICARE:  DR. RODRICK L BARDEN  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
11223E0200XEndodontics011598GA

General Provider Information

NPI Number : 1568542165
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RODRICK L BARDEN D.M.D.
Provider Business Mailing Address
First Line : 155 CARNEGIE PL
Second Line : SUITE 201
City : FAYETTEVILLE
State : GA
Zip : 30214-3981
Country : US
Telephone Number : 770-719-3600
Fax Number :
Provider Business Practice Location Address
First Line : 155 CARNEGIE PL
Second Line : SUITE 201
City : FAYETTEVILLE
State : GA
Zip : 30214-3981
Country : US
Telephone Number : 770-719-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2006
Last Update Date : 07/08/2007

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