Provider Demographics
NPI:1720072168
Name:BARKETT, PAMELA A (DDS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:BARKETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LISBON ST
Mailing Address - Street 2:PO BOX 335
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1415
Mailing Address - Country:US
Mailing Address - Phone:330-533-5666
Mailing Address - Fax:330-533-5270
Practice Address - Street 1:13 LISBON ST
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1415
Practice Address - Country:US
Practice Address - Phone:330-533-5666
Practice Address - Fax:330-533-5270
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH523119OtherUNITED CONCORDIA ID