Provider Demographics
NPI:1164710851
Name:KIM BARKER DDS CORP
Entity Type:Organization
Organization Name:KIM BARKER DDS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-584-6894
Mailing Address - Street 1:115 HYDE PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4524
Mailing Address - Country:US
Mailing Address - Phone:817-645-7201
Mailing Address - Fax:817-645-5273
Practice Address - Street 1:115 HYDE PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4524
Practice Address - Country:US
Practice Address - Phone:817-645-7201
Practice Address - Fax:817-645-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty