Provider Demographics
NPI:1063420032
Name:BARKER, WILLIAM JASON (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JASON
Last Name:BARKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 HARRODSBURG RD
Mailing Address - Street 2:SUITE B-395
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3751
Mailing Address - Country:US
Mailing Address - Phone:859-278-5377
Mailing Address - Fax:859-278-0903
Practice Address - Street 1:1401 HARRODSBURG RD
Practice Address - Street 2:SUITE B-395
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3751
Practice Address - Country:US
Practice Address - Phone:859-278-5377
Practice Address - Fax:859-278-0903
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY60881223S0112X
KY6088204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4578347OtherAETNA DENTAL
503927OtherUNITED CONCORDIA
000000108567OtherBCBS
KY60060880OtherMEDICAID DENTAL
18162OtherAETNA MEDICAL
KY64060882Medicaid
KY60060880OtherMEDICAID DENTAL
KY64060882Medicaid