Provider Demographics
NPI:1710009261
Name:BARKER, JOHN TYRON (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TYRON
Last Name:BARKER
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 1:636 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-2545
Mailing Address - Country:US
Mailing Address - Phone:828-728-4231
Mailing Address - Fax:828-728-4232
Practice Address - Street 1:636 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NC
Practice Address - Zip Code:28638-2545
Practice Address - Country:US
Practice Address - Phone:828-728-4231
Practice Address - Fax:828-728-4232
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990425Medicaid