Provider Demographics
NPI:1013223965
Name:BARCKHAUSEN, DEBORAH (DMD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:BARCKHAUSEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SE 73RD PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-6644
Mailing Address - Country:US
Mailing Address - Phone:352-629-7878
Mailing Address - Fax:
Practice Address - Street 1:7668 SW 60TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6401
Practice Address - Country:US
Practice Address - Phone:352-629-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-28
Last Update Date:2010-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN152721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics