Provider Demographics
NPI:1396067955
Name:BARTA, JAMES EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWARD
Last Name:BARTA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2215 WILLAMETTE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2847
Mailing Address - Country:US
Mailing Address - Phone:541-345-4076
Mailing Address - Fax:541-686-4834
Practice Address - Street 1:2215 WILLAMETTE ST
Practice Address - Street 2:SUITE A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2847
Practice Address - Country:US
Practice Address - Phone:541-345-4076
Practice Address - Fax:541-686-4834
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR58971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5897OtherSTATE LICENSE NUMBER
ORU05983Medicare UPIN