Provider Demographics
NPI:1275376048
Name:BARKER, DOMINIC ELI (DDS)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:ELI
Last Name:BARKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 TERRA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-1538
Mailing Address - Country:US
Mailing Address - Phone:620-331-9144
Mailing Address - Fax:
Practice Address - Street 1:112 E GREGORY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1120
Practice Address - Country:US
Practice Address - Phone:816-327-1841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240219581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice