Provider Demographics
NPI:1619959483
Name:BARTA, GUY ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:ALLEN
Last Name:BARTA
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 1:138 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-2038
Mailing Address - Country:US
Mailing Address - Phone:402-426-4176
Mailing Address - Fax:402-426-5085
Practice Address - Street 1:138 S 17TH ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-2038
Practice Address - Country:US
Practice Address - Phone:402-426-4176
Practice Address - Fax:402-426-5085
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE4953OtherBCBS
NE71089268300Medicaid