Provider Demographics
NPI:1568542165
Name:BARDEN, RODRICK L (DMD)
Entity Type:Individual
Prefix:DR
First Name:RODRICK
Middle Name:L
Last Name:BARDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CARNEGIE PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-3981
Mailing Address - Country:US
Mailing Address - Phone:770-719-3600
Mailing Address - Fax:
Practice Address - Street 1:155 CARNEGIE PL
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-3981
Practice Address - Country:US
Practice Address - Phone:770-719-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0115981223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics