Provider Demographics
NPI:1164902334
Name:BARRICKMAN, ZACHARY ADAM (DDS)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ADAM
Last Name:BARRICKMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX H
Mailing Address - Street 2:
Mailing Address - City:COPPER CENTER
Mailing Address - State:AK
Mailing Address - Zip Code:99573-0508
Mailing Address - Country:US
Mailing Address - Phone:907-822-5241
Mailing Address - Fax:
Practice Address - Street 1:MILE 111.5 RICHARDSON HWY
Practice Address - Street 2:
Practice Address - City:COPPER CENTER
Practice Address - State:AK
Practice Address - Zip Code:99573-0508
Practice Address - Country:US
Practice Address - Phone:907-822-5241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK131969122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist