Provider Demographics
NPI:1578659702
Name:LACK, BARBARA JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JEAN
Last Name:LACK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9720 RESEDA BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-5515
Mailing Address - Country:US
Mailing Address - Phone:818-349-5441
Mailing Address - Fax:818-349-5452
Practice Address - Street 1:9720 RESEDA BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-5515
Practice Address - Country:US
Practice Address - Phone:818-349-5441
Practice Address - Fax:818-349-5452
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist