Provider Demographics
NPI:1093854481
Name:BARLOCK, JASON D
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:BARLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15241 CORTONA WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-0673
Mailing Address - Country:US
Mailing Address - Phone:239-776-4633
Mailing Address - Fax:
Practice Address - Street 1:8595 COLLEGE PKWY
Practice Address - Street 2:SUITE B-5
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-5191
Practice Address - Country:US
Practice Address - Phone:239-433-0921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN158031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics