Provider Demographics
NPI:1114009255
Name:MICHAEL W. BARBA
Entity Type:Organization
Organization Name:MICHAEL W. BARBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BARBA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:641-423-2172
Mailing Address - Street 1:1453 4TH ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4437
Mailing Address - Country:US
Mailing Address - Phone:641-423-2172
Mailing Address - Fax:641-421-4166
Practice Address - Street 1:1453 4TH ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4437
Practice Address - Country:US
Practice Address - Phone:641-423-2172
Practice Address - Fax:641-421-4166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7089261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0456699Medicaid