Provider Demographics
NPI:1669812673
Name:ZICKGRAF, BARBARA BAUER (DDS)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:BAUER
Last Name:ZICKGRAF
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 1:10207 CERNY ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7878
Mailing Address - Country:US
Mailing Address - Phone:919-336-2981
Mailing Address - Fax:
Practice Address - Street 1:10207 CERNY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7878
Practice Address - Country:US
Practice Address - Phone:919-336-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010224661223G0001X
NC95751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice