Provider Demographics
NPI:1639887516
Name:DIVINE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DIVINE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BARKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-893-2106
Mailing Address - Street 1:321 DIVEN CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2707
Mailing Address - Country:US
Mailing Address - Phone:614-893-2106
Mailing Address - Fax:
Practice Address - Street 1:6465 E. BROAD ST
Practice Address - Street 2:STE C
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068
Practice Address - Country:US
Practice Address - Phone:614-893-2106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental