Provider Demographics
NPI:1427008382
Name:BARTS, DAVID JOE (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOE
Last Name:BARTS
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 1:1360 E 4TH ST
Mailing Address - Street 2:PO BOX 667
Mailing Address - City:ROCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46975-9103
Mailing Address - Country:US
Mailing Address - Phone:574-223-7792
Mailing Address - Fax:574-224-7792
Practice Address - Street 1:1360 E 4TH ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46975-9103
Practice Address - Country:US
Practice Address - Phone:574-223-7792
Practice Address - Fax:574-224-7792
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009107A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100118590AMedicaid