Provider Demographics
NPI:1326155771
Name:BARKLEY, RANDALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:
Last Name:BARKLEY
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 1:3600 HULEN ST
Mailing Address - Street 2:STE B-1
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-6863
Mailing Address - Country:US
Mailing Address - Phone:817-732-3230
Mailing Address - Fax:817-732-4024
Practice Address - Street 1:3600 HULEN ST
Practice Address - Street 2:STE B-1
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6863
Practice Address - Country:US
Practice Address - Phone:817-732-3230
Practice Address - Fax:817-732-4024
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121681223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0910671Medicaid