Provider Demographics
NPI:1679635320
Name:BARKLEY, PHILLIP JEFF (DMD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JEFF
Last Name:BARKLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5643 HWY 18 SOUTH
Mailing Address - Street 2:SUITE G
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209
Mailing Address - Country:US
Mailing Address - Phone:601-922-0056
Mailing Address - Fax:601-922-0056
Practice Address - Street 1:5643 HWY 18 SOUTH
Practice Address - Street 2:SUITE G
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209
Practice Address - Country:US
Practice Address - Phone:601-922-0056
Practice Address - Fax:601-922-0056
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS303398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist