Provider Demographics
NPI:1609142090
Name:MARK E. BARNARD, D.M.D., PC
Entity Type:Organization
Organization Name:MARK E. BARNARD, D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-538-3129
Mailing Address - Street 1:902 DEBORAH RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2001
Mailing Address - Country:US
Mailing Address - Phone:503-538-3129
Mailing Address - Fax:503-538-3120
Practice Address - Street 1:902 DEBORAH RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2001
Practice Address - Country:US
Practice Address - Phone:503-538-3129
Practice Address - Fax:503-538-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty