Provider Demographics
NPI:1427068469
Name:BARKER, GARY ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ALLEN
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 1:347 W SPRING ST
Mailing Address - Street 2:P.O. BOX 292
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1045
Mailing Address - Country:US
Mailing Address - Phone:740-942-3311
Mailing Address - Fax:740-942-2284
Practice Address - Street 1:347 W SPRING ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-1045
Practice Address - Country:US
Practice Address - Phone:740-942-3311
Practice Address - Fax:740-942-2284
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-57231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372494Medicaid
OH30-01-5723OtherOHIO DENTAL LICENSE