Provider Demographics
NPI:1043323215
Name:PACKER, BARLOW L (DDS)
Entity Type:Individual
Prefix:
First Name:BARLOW
Middle Name:L
Last Name:PACKER
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 1:1275 FORT UNION BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-1895
Mailing Address - Country:US
Mailing Address - Phone:801-566-5959
Mailing Address - Fax:801-304-9322
Practice Address - Street 1:1275 FORT UNION BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1895
Practice Address - Country:US
Practice Address - Phone:801-566-5959
Practice Address - Fax:801-304-9322
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT131845-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT830602OtherUNITED CONCORDIA