MEDICARE: DR. JOHN Y. BARLOW 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	278706-9922	UT
2	1223G0001X	General Practice Dentistry	22607	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24-5710792	OTHER	UT	FEIN
2	197013	OTHER	AZ	AHCCCS PROVIDER

General Provider Information

NPI Number	:	1619972569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN Y. BARLOW D.D.S.

Provider Business Mailing Address
First Line	:	1080 WEST UTAH AVE
Second Line	:	P.O. BOX 841489
City	:	HILDALE
State	:	UT
Zip	:	84784-1489
Country	:	US
Telephone Number	:	435-874-2555
Fax Number	:	435-874-2553

Provider Business Practice Location Address
First Line	:	1080 WEST UTAH AVE
Second Line	:
City	:	HILDALE
State	:	UT
Zip	:	84784-1489
Country	:	US
Telephone Number	:	435-874-2555
Fax Number	:	435-874-2553

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/24/2012

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