Provider Demographics
NPI:1003974478
Name:BARKER, BYRON EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:EDWARD
Last Name:BARKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 WASHINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:63349
Mailing Address - Country:US
Mailing Address - Phone:618-654-4166
Mailing Address - Fax:618-654-3099
Practice Address - Street 1:1117 WASHINGTON ST.
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:63349
Practice Address - Country:US
Practice Address - Phone:618-654-4166
Practice Address - Fax:618-654-3099
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice