Provider Demographics
NPI:1124393434
Name:BARRY G ACKER DDS PA
Entity Type:Organization
Organization Name:BARRY G ACKER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:ACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-597-2848
Mailing Address - Street 1:3100 NEW COPELAND RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-7940
Mailing Address - Country:US
Mailing Address - Phone:903-597-2848
Mailing Address - Fax:903-593-9626
Practice Address - Street 1:3100 NEW COPELAND RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-7940
Practice Address - Country:US
Practice Address - Phone:903-597-2848
Practice Address - Fax:903-593-9626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4521923OtherAETNA
TX120698902Medicaid
TX120698906Medicaid
TX844377OtherUNITED CONCORDIA
TX844377OtherUNITED CONCORDIA
TX120698902Medicaid