Provider Demographics
NPI:1962607804
Name:DR BARBARA J UTERMARK PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:DR BARBARA J UTERMARK PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PEDIATRIC DENTISTRY AND PRES
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:UTERMARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PC
Authorized Official - Phone:706-860-5884
Mailing Address - Street 1:4469-B COLUMBIA ROAD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4573
Mailing Address - Country:US
Mailing Address - Phone:706-860-5884
Mailing Address - Fax:706-860-2100
Practice Address - Street 1:4469-B COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4573
Practice Address - Country:US
Practice Address - Phone:706-860-5884
Practice Address - Fax:706-860-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty