Provider Demographics
NPI:1114182714
Name:MARK A. BARBER D.D.S. P.A.
Entity Type:Organization
Organization Name:MARK A. BARBER D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-336-2300
Mailing Address - Street 1:718 SE BECKER RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6621
Mailing Address - Country:US
Mailing Address - Phone:772-336-2300
Mailing Address - Fax:772-336-5642
Practice Address - Street 1:718 SE BECKER RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-6621
Practice Address - Country:US
Practice Address - Phone:772-336-2300
Practice Address - Fax:772-336-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-23
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0010705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty